Provider Demographics
NPI:1730303454
Name:FENTY, WILLIAM PATRICK II (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:PATRICK
Last Name:FENTY
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:31 MELROSE RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5610
Mailing Address - Country:US
Mailing Address - Phone:631-425-1168
Mailing Address - Fax:631-673-0313
Practice Address - Street 1:31 MELROSE RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5610
Practice Address - Country:US
Practice Address - Phone:631-425-1168
Practice Address - Fax:631-673-0313
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054186R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical