MEDICARE: ANGELA FAHMY

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	37PC00528100	NJ

General Provider Information

NPI Number	:	1225409576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA FAHMY

Provider Business Mailing Address
First Line	:	6 CLIFFWOOD CT
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-1460
Country	:	US
Telephone Number	:	908-380-2487
Fax Number	:

Provider Business Practice Location Address
First Line	:	728 BENNETTS MILLS RD
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-3850
Country	:	US
Telephone Number	:	732-491-8710
Fax Number	:

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

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	10/13/2015

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