Provider Demographics
NPI:1548638109
Name:FENSTER, SUSAN JILL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JILL
Last Name:FENSTER
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 1:4242 STRATHDALE LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3143
Mailing Address - Country:US
Mailing Address - Phone:248-229-1154
Mailing Address - Fax:
Practice Address - Street 1:15700 W 10 MILE RD
Practice Address - Street 2:SUITE 213
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2149
Practice Address - Country:US
Practice Address - Phone:989-225-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010668531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical