Provider Demographics
NPI:1316143415
Name:FENERTY-LANGE, HELEN JEAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:HELEN
Middle Name:JEAN
Last Name:FENERTY-LANGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19972 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971
Mailing Address - Country:US
Mailing Address - Phone:302-727-3439
Mailing Address - Fax:302-645-8036
Practice Address - Street 1:17021 ORCHARD ROAD
Practice Address - Street 2:SUITE 1A
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-727-3439
Practice Address - Fax:302-645-8036
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00012181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA099190Medicare ID - Type UnspecifiedMEDICARE ID FOR BILLING