Healthcare Provider Details

I. General information

NPI: 1437238979
Provider Name (Legal Business Name): FRANCINE FONFEDER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670-78 EAST 17TH STREET 3RD FL.
BROOKLYN NY
11229
US

IV. Provider business mailing address

1817 E 18TH ST
BROOKLYN NY
11229-2914
US

V. Phone/Fax

Practice location:
  • Phone: 718-375-1200
  • Fax: 718-382-3358
Mailing address:
  • Phone: 718-382-1457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001172-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: