Healthcare Provider Details

I. General information

NPI: 1356573547
Provider Name (Legal Business Name): CHEREE LOUISE FENSKE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 MAIN AVE STE 104
NORWALK CT
06851
US

IV. Provider business mailing address

103 ROCK SPRING RD UNIT 1
STAMFORD CT
06906-1954
US

V. Phone/Fax

Practice location:
  • Phone: 203-855-9691
  • Fax: 203-855-9791
Mailing address:
  • Phone: 917-566-4165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number002923
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number015866
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: