Provider Demographics
NPI:1922739333
Name:FENNELL, ANNA MARIE (EDM)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:FENNELL
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 W 57TH ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1705
Mailing Address - Country:US
Mailing Address - Phone:863-393-8533
Mailing Address - Fax:
Practice Address - Street 1:469 W 57TH ST APT 2C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1705
Practice Address - Country:US
Practice Address - Phone:863-393-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health