Provider Demographics
NPI:1902103260
Name:FENNELL, WALTER J (BS)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:J
Last Name:FENNELL
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:720 WOODLANE RD
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-9615
Mailing Address - Country:US
Mailing Address - Phone:609-267-5928
Mailing Address - Fax:856-768-0241
Practice Address - Street 1:128 CROSS KEYS RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9201
Practice Address - Country:US
Practice Address - Phone:856-210-1500
Practice Address - Fax:856-768-0241
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health