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General NPI Number Information
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NPI Number | 1821781329
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Entity Type | Individual
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Provider Name | ALDALICIA FONTANE MS
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Gender | Female
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Dates
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Enumeration Date | 05/31/2023
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 7000 AUSTIN ST STE 200
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City | FOREST HILLS
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State | NY
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Zip | 11375-4739
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Country | US
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Telephone | 718-762-7633
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Fax |
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Provider Business Mailing Address
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Address Line | 33 MOOS LN
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City | BERGENFIELD
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State | NJ
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Zip | 07621
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Country | US
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Telephone | 646-875-1895
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | NY
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