Provider Demographics
NPI:1558836072
Name:FANELLI, ANNE KATHLEEN (MED, MSW, LSW)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:KATHLEEN
Last Name:FANELLI
Suffix:
Gender:F
Credentials:MED, MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4142 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-1116
Mailing Address - Country:US
Mailing Address - Phone:267-255-4318
Mailing Address - Fax:
Practice Address - Street 1:4142 CREEK RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-1116
Practice Address - Country:US
Practice Address - Phone:267-255-4318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW-012931-L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker