Provider Demographics
NPI:1295160679
Name:FENELON, MANUEL ANTONIO (BEHAVIORAL THERAPIST)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:ANTONIO
Last Name:FENELON
Suffix:
Gender:M
Credentials:BEHAVIORAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-989 HANAUNA ST
Mailing Address - Street 2:1C
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4756
Mailing Address - Country:US
Mailing Address - Phone:808-779-2183
Mailing Address - Fax:
Practice Address - Street 1:210 WARD AVE
Practice Address - Street 2:219 B
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4008
Practice Address - Country:US
Practice Address - Phone:808-585-1424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst