Provider Demographics
NPI:1255405361
Name:FENDERSON, CAROLINE H (MA, PA)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:H
Last Name:FENDERSON
Suffix:
Gender:F
Credentials:MA, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25400 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 172
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-2149
Mailing Address - Country:US
Mailing Address - Phone:727-797-7211
Mailing Address - Fax:727-797-7211
Practice Address - Street 1:25400 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 172
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-2149
Practice Address - Country:US
Practice Address - Phone:727-797-7211
Practice Address - Fax:727-797-7211
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0000308101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health