Provider Demographics
NPI:1285186692
Name:FONTENOY, SERENA E (LMSW)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:E
Last Name:FONTENOY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:
Other - Last Name:WREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PSC 444 BOX 1008
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96297-0011
Mailing Address - Country:US
Mailing Address - Phone:501-256-0320
Mailing Address - Fax:
Practice Address - Street 1:UNIT 15245
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96271-5245
Practice Address - Country:US
Practice Address - Phone:315-737-5978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2025-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7955-M104100000X
AR7955-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker