Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1073763603 |
---|---|
Provider Name | Dr. Jeanette Chandlee Fahey |
First Address | Fort Washington, PA 19034-3403 |
Second Address | Fort Washington, PA 19034-3403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2008 |
Last Update Date | 18/09/2008 |