Active NPI
Marissa Fenner
- Social Worker
- Utica, NY
National Provider Identifier
1760067672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 110438-01
- Practice address
- 1 Kraemer PL Apt 2
Utica, NY 13502-6016 - Phone
- (315) 794-0448
- NPI assigned
- Mar 11, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 110438-01 | NY | Primary |
Addresses
Primary practice location
1 Kraemer PL Apt 2
Utica, NY 13502-6016
Mailing address
616 Mary St.
Utica, NY 13501
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W264481889 | Other | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110438-01 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615420800000",
"number": "1760067672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "616 MARY ST.",
"city": "UTICA",
"state": "NY",
"postal_code": "13501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 KRAEMER PL APT 2",
"city": "UTICA",
"state": "NY",
"postal_code": "135026016",
"telephone_number": "315-794-0448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENNER",
"first_name": "MARISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-11",
"last_updated": "2021-03-11",
"certification_date": "2021-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "110438-01",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "W264481889",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Utica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.