Individual
BRIDGET JUDITH PETERSON-FENNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
73 AMETHYST RD, PALMYRA, VA 22963-2414
(434) 589-4316
Mailing address
73 AMETHYST RD, PALMYRA, VA 22963-2414
(434) 589-4316
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904006965
VA
Other
Enumeration date
12/11/2014
Last updated
12/11/2014
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