Provider Demographics
NPI:1376576439
Name:FENDEL, BARBARA (MSSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:FENDEL
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 SALEM RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3018
Mailing Address - Country:US
Mailing Address - Phone:631-673-3115
Mailing Address - Fax:631-351-1105
Practice Address - Street 1:75 PROSPECT ST
Practice Address - Street 2:SUITE 111
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3382
Practice Address - Country:US
Practice Address - Phone:631-423-9021
Practice Address - Fax:631-351-1105
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR007259-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN40181Medicare ID - Type Unspecified