Provider Demographics
NPI:1144323593
Name:FORTNEY, JANINE A (LSW)
Entity type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:A
Last Name:FORTNEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FACTORYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18419-2808
Mailing Address - Country:US
Mailing Address - Phone:570-945-9556
Mailing Address - Fax:
Practice Address - Street 1:104 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FACTORYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18419-2808
Practice Address - Country:US
Practice Address - Phone:570-945-9556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW012000L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker