Provider Demographics
NPI:1356404370
Name:FELLENBERG, DONNA LYNN (MSW)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LYNN
Last Name:FELLENBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1610
Mailing Address - Country:US
Mailing Address - Phone:973-857-7888
Mailing Address - Fax:973-857-7888
Practice Address - Street 1:25 GROVE AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1631
Practice Address - Country:US
Practice Address - Phone:973-857-7888
Practice Address - Fax:973-857-7888
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00667800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health