Individual
MRS. AMY M FENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW
Contact information
Practice address
1519 NYE RD, SUITE 200, LYONS, NY 14489-9133
(315) 946-5749
Mailing address
1519 NYE RD, SUITE 200, LYONS, NY 14489-9133
(315) 946-5749
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00355899
—
NY
05
—
3001970
—
NY
Enumeration date
06/07/2012
Last updated
06/07/2012
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