Individual
VIRGINIA G FASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2 MAIN ST, SUITE 315, BRADFORD, PA 16701-2035
(814) 362-5579
(814) 368-5997
Mailing address
2 MAIN ST STE 315, PO BOX 370, BRADFORD, PA 16701-2037
(814) 362-5579
(814) 368-5997
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PS006376L
PA
Other
Enumeration date
04/03/2007
Last updated
01/22/2013
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