Provider Demographics
NPI:1801044326
Name:GLENN FELLENZER, ANNE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:GLENN FELLENZER
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 1:1711 STATE ROUTE 17A
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:NY
Mailing Address - Zip Code:10921-1065
Mailing Address - Country:US
Mailing Address - Phone:845-651-1848
Mailing Address - Fax:
Practice Address - Street 1:1711 STATE ROUTE 17A
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921-1065
Practice Address - Country:US
Practice Address - Phone:845-651-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0803991041C0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)