Provider Demographics
NPI:1578629689
Name:FENIMORE, MARTHA ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ELIZABETH
Last Name:FENIMORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-8807
Mailing Address - Country:US
Mailing Address - Phone:772-562-6533
Mailing Address - Fax:
Practice Address - Street 1:4225 61ST AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-8807
Practice Address - Country:US
Practice Address - Phone:772-562-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00027741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical