Provider Information for 1548380306
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Ms. MANOLITA M FENN msw
Sex: Female
NPI: 1548380306
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1548380306 | ||||||||
| Enumeration Date | 2007-03-29 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1 STEERS AVE NORTHPORT, NY 11768-1536 United States Phone: 917-612-6200 | Fax: | ||||||||
| Primary Practice Address | 1 STEERS AVE NORTHPORT, NY 11768-1536 United States Phone: 917-612-9200 | Fax: | ||||||||
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