Healthcare Provider Details

I. General information

NPI: 1366923211
Provider Name (Legal Business Name): TAMAME FONVILLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N OLDEN AVENUE EXT STE 29
EWING NJ
08618-2111
US

IV. Provider business mailing address

1901 N OLDEN AVENUE EXT STE 29
EWING NJ
08618-2111
US

V. Phone/Fax

Practice location:
  • Phone: 609-237-7100
  • Fax: 609-616-7904
Mailing address:
  • Phone: 609-237-7100
  • Fax: 609-616-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SC06616400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: