Provider Demographics
NPI:1629292008
Name:FENECK, LORI EILEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:EILEEN
Last Name:FENECK
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 1:1385 POCONO BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT POCONO
Mailing Address - State:PA
Mailing Address - Zip Code:18344-1678
Mailing Address - Country:US
Mailing Address - Phone:570-460-4379
Mailing Address - Fax:570-421-3600
Practice Address - Street 1:1385 POCONO BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344-1678
Practice Address - Country:US
Practice Address - Phone:570-460-4379
Practice Address - Fax:570-421-3600
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL053678001041C0700X
PACW0167421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101857158Medicaid