Healthcare Provider Details

I. General information

NPI: 1114686706
Provider Name (Legal Business Name): EMILY CAROLYN FENNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2021
Last Update Date: 04/13/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E LOUTHER ST STE 204
CARLISLE PA
17013-2646
US

IV. Provider business mailing address

401 E LOUTHER ST STE 204
CARLISLE PA
17013-2646
US

V. Phone/Fax

Practice location:
  • Phone: 717-686-9119
  • Fax:
Mailing address:
  • Phone: 717-918-9961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW022191
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: