Provider Demographics
NPI:1336500370
Name:FOURLAS, ALETHEA (LSW)
Entity Type:Individual
Prefix:
First Name:ALETHEA
Middle Name:
Last Name:FOURLAS
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 1:193 DICKENS DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-8858
Mailing Address - Country:US
Mailing Address - Phone:717-713-8157
Mailing Address - Fax:
Practice Address - Street 1:193 DICKENS DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-8858
Practice Address - Country:US
Practice Address - Phone:717-713-8157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130441104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100775933Medicaid
PA123987Medicare PIN