Provider Demographics
NPI:1518294156
Name:FAHNOE, ERIN COSTELLO (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:COSTELLO
Last Name:FAHNOE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:MAUREEN
Other - Last Name:COSTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1204 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-9620
Mailing Address - Country:US
Mailing Address - Phone:610-892-3800
Mailing Address - Fax:484-468-1412
Practice Address - Street 1:1055 E BALTIMORE PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5173
Practice Address - Country:US
Practice Address - Phone:610-892-3800
Practice Address - Fax:484-468-1412
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0148321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical