Provider Demographics
NPI:1912358417
Name:FENNICK, VASEFFA (LSW)
Entity Type:Individual
Prefix:
First Name:VASEFFA
Middle Name:
Last Name:FENNICK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-9576
Mailing Address - Country:US
Mailing Address - Phone:412-779-7251
Mailing Address - Fax:
Practice Address - Street 1:2616 WILMINGTON RD STE A
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1504
Practice Address - Country:US
Practice Address - Phone:724-652-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-26
Last Update Date:2016-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133513104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker