Individual
DR. DAVID LAURENCE FASK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
255 S 17TH ST, STE. 1010, PHILADELPHIA, PA 19103-6231
(484) 474-0353
Mailing address
255 S 17TH ST, STE. 1010, PHILADELPHIA, PA 19103-6231
(484) 474-0353
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
35SI00568700
NJ
103T00000X
Psychologist
Primary
PS018075
PA
Other
Enumeration date
07/19/2016
Last updated
09/09/2016
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