Individual
LISA FENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15 W PROSPECT ST, EAST BRUNSWICK, NJ 08816-2161
(732) 254-0600
Mailing address
15 W PROSPECT ST, EAST BRUNSWICK, NJ 08816-2161
(732) 254-0600
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
37FI00196000
NJ
Other
Enumeration date
01/05/2018
Last updated
02/18/2022
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