Provider Demographics
NPI:1154334605
Name:FANKHANEL, EDWARD H (MA, EDD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:FANKHANEL
Suffix:
Gender:M
Credentials:MA, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 CALLE ZAMBEZE
Mailing Address - Street 2:CROWN HILLS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6010
Mailing Address - Country:US
Mailing Address - Phone:787-754-7213
Mailing Address - Fax:
Practice Address - Street 1:134 CALLE ZAMBEZE
Practice Address - Street 2:CROWN HILLS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6010
Practice Address - Country:US
Practice Address - Phone:787-754-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6051101YM0800X
NY001578101YM0800X
PR993103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health