Provider Demographics
NPI:1083929061
Name:FAHY, JORJA EVE (EDM)
Entity Type:Individual
Prefix:
First Name:JORJA
Middle Name:EVE
Last Name:FAHY
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:WEST TOWNSEND
Mailing Address - State:MA
Mailing Address - Zip Code:01474-1057
Mailing Address - Country:US
Mailing Address - Phone:617-775-9343
Mailing Address - Fax:
Practice Address - Street 1:26 HORSESHOE DR
Practice Address - Street 2:
Practice Address - City:WEST TOWNSEND
Practice Address - State:MA
Practice Address - Zip Code:01474-1057
Practice Address - Country:US
Practice Address - Phone:617-775-9343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health