Healthcare Provider Details

I. General information

NPI: 1144323593
Provider Name (Legal Business Name): JANINE A FORTNEY LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 HIGHLAND AVE
FACTORYVILLE PA
18419-2808
US

IV. Provider business mailing address

104 HIGHLAND AVE
FACTORYVILLE PA
18419-2808
US

V. Phone/Fax

Practice location:
  • Phone: 570-945-9556
  • Fax:
Mailing address:
  • Phone: 570-945-9556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW012000L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: