Individual
MS. BERTHA FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
130 W KINGSBRIDGE RD, BRONX, NY 10468-3904
(212) 203-2213
Mailing address
39 DAVENPORT AVE APT 3G, NEW ROCHELLE, NY 10805-3407
(212) 203-2213
(914) 813-2739
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
034693
NY
Other
Enumeration date
07/19/2017
Last updated
07/19/2017
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