Healthcare Provider Details

I. General information

NPI: 1831203579
Provider Name (Legal Business Name): CHRISTINA FANTAUZZO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1082 TAYLORSVILLE RD STE 210
WASHINGTON CROSSING PA
18977-1305
US

IV. Provider business mailing address

1082 TAYLORSVILLE RD STE 210
WASHINGTON CROSSING PA
18977-1305
US

V. Phone/Fax

Practice location:
  • Phone: 267-291-4263
  • Fax: 267-361-1176
Mailing address:
  • Phone: 267-291-4263
  • Fax: 267-361-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number355100658400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS008893L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: