Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 37PC00666000 | NJ |
NPI | 1003455668 |
---|---|
Provider Name | Michael Fenimore |
First Address | Hazlet, NJ 07730-1531 |
Second Address | Hazlet, NJ 07730-1531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2019 |
Last Update Date | 31/12/2019 |