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General NPI Number Information
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NPI Number | 1659236412
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Entity Type | Individual
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Provider Name | MARY ANN FORTUN
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Gender | Female
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Dates
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Enumeration Date | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 54 MYRTLE ST
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City | BELMONT
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State | NC
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Zip | 28012-5200
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Country | US
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Telephone | 704-954-8959
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Fax |
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Provider Business Mailing Address
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Address Line | 1688 LOWELL BETHESDA RD APT M
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City | GASTONIA
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State | NC
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Zip | 28056-3612
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Country | US
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Telephone | 704-913-7005
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | NC
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