MEDICARE: FATIMA CARMONA MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1871773499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATIMA CARMONA MA

Provider Business Mailing Address
First Line	:	2030 W TILGHMAN ST
Second Line	:	SUITE 105B
City	:	ALLENTOWN
State	:	PA
Zip	:	18104-4354
Country	:	US
Telephone Number	:	484-221-9136
Fax Number	:	484-221-9130

Provider Business Practice Location Address
First Line	:	2927 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2800
Country	:	US
Telephone Number	:	484-221-9136
Fax Number	:	484-221-9130

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2007
Last Update Date	:	11/12/2007

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Directions to “ FATIMA CARMONA MA” Practice Location

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