Doctor Name: | MS. ALICE T FENNESSEY |
NPI Number: | 1821364183 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | 006267 |
Business Practice Address: | 264 Mckinstry Rd Gardiner, NY - 125255134 |
Business Phone Number: | 8454192388 |
Business Fax Number: | 8452551569 |
Mailing Address: | 264 Mckinstry Rd, GARDINER |
State: | NY |
Postal Code: | 125255134 |
Phone Number: | 8454192388 |
Fax Number: | 8452551569 |
NPI Enumeration Date: | 03/30/2012 |
NPI Last Update Date: | 03/30/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 006267 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |