Individual
LAUREN MICHELLE FUSSNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(614) 578-9150
Mailing address
2332 CARPENTER ST APT 2D, PHILADELPHIA, PA 19146-2511
(614) 578-9150
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
3751
CT
103TC2200X
Clinical Child & Adolescent Psychologist
3751
CT
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PS019034
PA
Other
Enumeration date
08/29/2018
Last updated
06/09/2020
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