Individual
LAWRENCE FANTL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
529 COURTLANDT AVE, BRONX, NY 10451-5007
(718) 993-7700
Mailing address
529 COURTLANDT AVE, BRONX, NY 10451-5007
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
7556
NY
Other
Enumeration date
11/04/2020
Last updated
11/04/2020
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