MEDICARE: BRITTANY FAIR M.A., NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1093110652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY FAIR M.A., NCC

Provider Business Mailing Address
First Line	:	770 WOODLANE RD
Second Line	:
City	:	WESTAMPTON
State	:	NJ
Zip	:	08060-3804
Country	:	US
Telephone Number	:	609-267-5928
Fax Number	:

Provider Business Practice Location Address
First Line	:	1138 E CHESTNUT AVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08360-5053
Country	:	US
Telephone Number	:	856-696-1233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2014
Last Update Date	:	10/24/2014

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