Provider Demographics
NPI:1730206525
Name:FENNEWALD, ROBERT JOSEPH (MS, LMHC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:FENNEWALD
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 BRIELLE AVE
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5406
Mailing Address - Country:US
Mailing Address - Phone:407-648-7423
Mailing Address - Fax:407-366-1275
Practice Address - Street 1:934 N MAGNOLIA AVE STE 234
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3889
Practice Address - Country:US
Practice Address - Phone:407-648-7423
Practice Address - Fax:407-366-1275
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health