Provider Demographics
NPI:1285091223
Name:FENDER- BLAKE, FIONA
Entity type:Individual
Prefix:
First Name:FIONA
Middle Name:
Last Name:FENDER- BLAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 E 228TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4423
Mailing Address - Country:US
Mailing Address - Phone:646-702-7495
Mailing Address - Fax:
Practice Address - Street 1:856 E 228TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4423
Practice Address - Country:US
Practice Address - Phone:646-702-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor