Provider Demographics
NPI:1972725505
Name:FENYOE, MEGAN RUE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:RUE
Last Name:FENYOE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:RUE
Other - Last Name:TIERI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:6801 LEISURE TOWN RD APT 27
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-9435
Mailing Address - Country:US
Mailing Address - Phone:616-460-4529
Mailing Address - Fax:
Practice Address - Street 1:744 EMPIRE ST
Practice Address - Street 2:SUITE 230
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5510
Practice Address - Country:US
Practice Address - Phone:616-460-4529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085660104100000X
CA703811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker