Individual
AMY FANTALIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, MSW, LCSW
Contact information
Practice address
42 E FRONT ST, MEDIA, PA 19063-2912
(610) 627-9060
Mailing address
42 E FRONT ST, MEDIA, PA 19063-2912
(610) 627-9060
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW012471
PA
Other
Enumeration date
01/22/2013
Last updated
01/22/2013
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