Healthcare Provider Details

I. General information

NPI: 1053374850
Provider Name (Legal Business Name): NANCY M FENSTERMACHER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY M FENSTERMACHER ROSS PSYD

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S FRONT STREET 5TH FLOOR
HARRISBURG PA
17104-1619
US

IV. Provider business mailing address

118 WASHINGTON STREET
HARRISBURG PA
17104-1612
US

V. Phone/Fax

Practice location:
  • Phone: 717-231-8360
  • Fax: 717-231-8358
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS007110L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: