Provider Demographics
NPI:1306411947
Name:LUO, FANG YU
Entity Type:Individual
Prefix:
First Name:FANG YU
Middle Name:
Last Name:LUO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:
Other - Last Name:LUO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1424 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-2318
Mailing Address - Country:US
Mailing Address - Phone:267-809-3528
Mailing Address - Fax:
Practice Address - Street 1:1424 MOORE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2318
Practice Address - Country:US
Practice Address - Phone:267-809-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012564101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health