Doctor Name: | WILLIAM R. FATUM |
NPI Number: | 1295943116 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 37PC00088900 |
Business Practice Address: | 30 Tecumseh Trl Browns Mills, NJ - 080156108 |
Business Phone Number: | 6098535600 |
Business Fax Number: | 6098933082 |
Mailing Address: | Po Box 207, NEW LISBON |
State: | NJ |
Postal Code: | 080640207 |
Phone Number: | 6098535600 |
Fax Number: | 6098933082 |
NPI Enumeration Date: | 05/21/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 37PC00088900 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |