Provider Demographics
NPI:1700607322
Name:FENICHEL, TERESA (LCSW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:FENICHEL
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 1:2 MARIAN LANE #459
Mailing Address - Street 2:
Mailing Address - City:TRURO
Mailing Address - State:MA
Mailing Address - Zip Code:02666
Mailing Address - Country:US
Mailing Address - Phone:617-686-7873
Mailing Address - Fax:
Practice Address - Street 1:2 MARIAN LANE #459
Practice Address - Street 2:
Practice Address - City:TRURO
Practice Address - State:MA
Practice Address - Zip Code:02666
Practice Address - Country:US
Practice Address - Phone:617-686-7873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2285011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical