Provider Demographics
NPI:1205250743
Name:FEHRENBACH, SHELLEY HOPE (LCSW)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:HOPE
Last Name:FEHRENBACH
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 1:7 GATSBY LN
Mailing Address - Street 2:
Mailing Address - City:KINGS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1000
Mailing Address - Country:US
Mailing Address - Phone:516-487-3592
Mailing Address - Fax:516-466-1046
Practice Address - Street 1:300 GARDEN CITY PLZ
Practice Address - Street 2:SUITE 3 400
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3302
Practice Address - Country:US
Practice Address - Phone:516-248-0006
Practice Address - Fax:516-248-0603
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078296-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical