Healthcare Provider Details

I. General information

NPI: 1235055385
Provider Name (Legal Business Name): DORIS ELDICA THOMPSON-FOFANAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 N SCOTT ST
CARBONDALE PA
18407-1888
US

IV. Provider business mailing address

38 N SCOTT ST
CARBONDALE PA
18407-1888
US

V. Phone/Fax

Practice location:
  • Phone: 570-280-2800
  • Fax: 570-281-6245
Mailing address:
  • Phone: 570-280-2800
  • Fax: 570-281-6245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH007111
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: