Healthcare Provider Details

I. General information

NPI: 1154334605
Provider Name (Legal Business Name): EDWARD H FANKHANEL MA, ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 CALLE ZAMBEZE CROWN HILLS
SAN JUAN PR
00926-6010
US

IV. Provider business mailing address

134 CALLE ZAMBEZE CROWN HILLS
SAN JUAN PR
00926-6010
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-7213
  • Fax:
Mailing address:
  • Phone: 787-754-7213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6051
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001578
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number993
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: