Provider Demographics
NPI:1154741619
Name:FENSTER, CAROL (LCSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:FENSTER
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 1:7888 SW 102ND LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-8117
Mailing Address - Country:US
Mailing Address - Phone:305-401-7676
Mailing Address - Fax:
Practice Address - Street 1:7000 SW 62ND AVE
Practice Address - Street 2:SUITE 525
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4716
Practice Address - Country:US
Practice Address - Phone:305-401-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW16411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1649OtherMEDICARE