Provider Demographics
NPI:1770197543
Name:FENLEY, ROBIN E (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:E
Last Name:FENLEY
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MOUNTAINVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5315
Mailing Address - Country:US
Mailing Address - Phone:917-282-3063
Mailing Address - Fax:
Practice Address - Street 1:223 MOUNTAINVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5315
Practice Address - Country:US
Practice Address - Phone:917-282-3063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071277-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical