Active NPI
Patricia Ann Fennelly, PHD
- Clinical Psychologist
- Londonderry, NH
National Provider Identifier
1295835965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 459
- Practice address
- 13 Orchard View Dr
Suite 5
Londonderry, NH 03053-3457 - Phone
- (603) 421-0059
- NPI assigned
- Sep 23, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 459 | NH | Primary |
Addresses
Primary practice location
13 Orchard View Dr
Suite 5
Londonderry, NH 03053-3457
Mailing address
13 Orchard View Dr
Suite 5
Londonderry, NH 03053-3457
Phone (603) 421-0059
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051020000990 | NH | Practitioner - Clinical Psychologist | 6204852015 | Practice locations: Manchester, NH |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
41 Brook St
Suite 1
Manchester, NH 03104-3599
Phone (603) 935-8785
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295835965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13 ORCHARD VIEW DR",
"address_2": "SUITE 5",
"city": "LONDONDERRY",
"state": "NH",
"postal_code": "030533457",
"telephone_number": "603-421-0059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13 ORCHARD VIEW DR",
"address_2": "SUITE 5",
"city": "LONDONDERRY",
"state": "NH",
"postal_code": "030533457",
"telephone_number": "603-421-0059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENNELLY",
"first_name": "PATRICIA",
"middle_name": "ANN",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NH",
"license": "459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Londonderry, NH
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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.