Individual
FATIMA FOFANAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2 LOGAN SQ STE 300, PHILADELPHIA, PA 19103-2733
(888) 922-2843
(855) 568-2494
Mailing address
2616 S SYLMAR ST, PHILADELPHIA, PA 19142-2125
(215) 607-9832
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
PA
Other
Enumeration date
04/30/2022
Last updated
04/30/2022
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