MEDICARE: STEPHANIE ANN FESSENDEN LCSW, LMHC, LCADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	00504-C	NV
2	1041C0700X	Clinical Social Worker	7737-C	NV
3	1041C0700X	Clinical Social Worker	73-079960	NY

General Provider Information

NPI Number	:	1912130386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ANN FESSENDEN LCSW, LMHC, LCADC

Provider Business Mailing Address
First Line	:	9028 WATERFIELD CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6193
Country	:	US
Telephone Number	:	914-263-3757
Fax Number	:

Provider Business Practice Location Address
First Line	:	9028 WATERFIELD CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6193
Country	:	US
Telephone Number	:	914-263-3757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2009
Last Update Date	:	12/20/2018

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