Provider Demographics
NPI:1659522282
Name:FENTON, LOUISE I (MASTERS)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:I
Last Name:FENTON
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35593
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13235-0593
Mailing Address - Country:US
Mailing Address - Phone:315-399-8903
Mailing Address - Fax:
Practice Address - Street 1:2507 JAMES ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2825
Practice Address - Country:US
Practice Address - Phone:315-399-8903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR044127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health