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General NPI Number Information
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NPI Number | 1811545627
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Entity Type | Individual
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Provider Name | FENNEL EDWARD KPOLIE LSW
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Gender | Male
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 1239 PARKWAY AVE STE 102
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City | EWING
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State | NJ
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Zip | 08628-3000
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Country | US
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Telephone | 609-394-3010
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Fax | 609-394-3010
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Provider Business Mailing Address
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Address Line | 4512 KIRKWOOD HWY STE 300
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City | WILMINGTON
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State | DE
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Zip | 19808-5129
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Country | US
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Telephone | 302-623-7515
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | Q1-0012005
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL05587600
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License Number State | NJ
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