Healthcare Provider Details

I. General information

NPI: 1235866716
Provider Name (Legal Business Name): MARY FENSHAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 S MAIN ST
MARLBORO NJ
07746-1539
US

IV. Provider business mailing address

1 RIVERVIEW PLZ
RED BANK NJ
07701-1864
US

V. Phone/Fax

Practice location:
  • Phone: 848-325-7800
  • Fax:
Mailing address:
  • Phone: 908-721-6739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06592800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: