Provider Demographics
NPI:1760728364
Name:FENTY-MUNRO, TRISHANNE (MSW)
Entity Type:Individual
Prefix:
First Name:TRISHANNE
Middle Name:
Last Name:FENTY-MUNRO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TRISHANNE
Other - Middle Name:
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:4060 WATSON PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-4033
Mailing Address - Country:US
Mailing Address - Phone:626-712-6793
Mailing Address - Fax:
Practice Address - Street 1:4060 WATSON PLAZA DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-4033
Practice Address - Country:US
Practice Address - Phone:626-712-6793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34153101Y00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor