Individual provider Active NPI

Anne Marie Glenn Fellenzer, LCSW

  • Clinical Social Worker
  • Florida, NY
National Provider Identifier
1801044326
Registry record updated Apr 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
080399 Issued in NY
Practice address
1711 State Route 17a
Florida, NY 10921-1065
Phone
(845) 651-1848
NPI assigned
Sep 9, 2008
Last updated
Apr 4, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 080399 NY Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X

Addresses

Primary practice location

1711 State Route 17a
Florida, NY 10921-1065

Mailing address

1711 State Route 17a
Florida, NY 10921-1065
Phone (845) 651-1848

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140709000666 NY Practitioner - Clinical Social Worker 3375768245 Reassigns benefits to 1 organization
Practice locations: Goshen, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
County of OrangeGroup PAC ID 0648169185, 28 clinicians

Practice addresses (Care Compare)

146 Pike St
Port Jervis, NY 12771-1808
Phone (845) 856-1458

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
080399NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
County of Orange CurrentSince Jul 23, 2018 Accepting new patients
County of Orange CurrentSince Jul 23, 2018 Accepting new patients
County of Orange Current Accepting new patients

Locations

30 Harriman Dr
Goshen, NY 10924
Phone (845) 291-2600

146 Pike St
Port Jervis, NY 12771
Phone (845) 856-1458

Organizations & group practices 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396569600000",
    "number": "1801044326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 STATE ROUTE 17A",
            "city": "FLORIDA",
            "state": "NY",
            "postal_code": "109211065",
            "telephone_number": "845-651-1848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 STATE ROUTE 17A",
            "city": "FLORIDA",
            "state": "NY",
            "postal_code": "109211065",
            "telephone_number": "845-651-1848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN FELLENZER",
        "first_name": "ANNE",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-09",
        "last_updated": "2014-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "080399",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florida, NY

Sources for this page

Verify at the official NPI Registry.