Provider Demographics
NPI:1548380579
Name:FORTUNE, JOANNE H (PH D, LMHC)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:H
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:PH D, LMHC
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:H
Other - Last Name:DELAPAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:872 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4633
Mailing Address - Country:US
Mailing Address - Phone:516-242-3523
Mailing Address - Fax:
Practice Address - Street 1:872 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4633
Practice Address - Country:US
Practice Address - Phone:516-242-3523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003409101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health