Active NPI
Leo F Fenzel Jr., PH.D.
- Psychologist
- Towson, MD
National Provider Identifier
1124106000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 02810
- Practice address
- 28 Allegheny Ave
Suite 1208
Towson, MD 21204-3909 - Phone
- (410) 617-2640
- Fax
- (410) 617-5097
- NPI assigned
- Nov 1, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 02810 | MD | Primary |
Addresses
Primary practice location
28 Allegheny Ave
Suite 1208
Towson, MD 21204-3909
Mailing address
28 Allegheny Ave
Suite 1208
Towson, MD 21204-3909
Phone (410) 617-2640
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02810 | Other | MD | PSYCHOLOGIST LICENSE |
Other names 1
- Dr. Mickey Fenzel
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Safe Harbor Community Services | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Bel Air, MD
- NPI 1184209447
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124106000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28 ALLEGHENY AVE",
"address_2": "SUITE 1208",
"city": "TOWSON",
"state": "MD",
"postal_code": "212043909",
"telephone_number": "410-617-2640",
"fax_number": "410-617-5097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28 ALLEGHENY AVE",
"address_2": "SUITE 1208",
"city": "TOWSON",
"state": "MD",
"postal_code": "212043909",
"telephone_number": "410-617-2640",
"fax_number": "410-617-5097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENZEL",
"first_name": "LEO",
"middle_name": "F",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MD",
"license": "02810",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGIST LICENSE",
"identifier": "02810",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MICKEY",
"last_name": "FENZEL",
"prefix": "DR.",
"credential": "PH.D.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Towson, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.