Provider Demographics
NPI:1578848909
Name:FORTIER, DANA SUZANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:SUZANNE
Last Name:FORTIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E HOME AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-1725
Mailing Address - Country:US
Mailing Address - Phone:559-786-4737
Mailing Address - Fax:
Practice Address - Street 1:625 E HOME AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-1725
Practice Address - Country:US
Practice Address - Phone:559-786-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS141231041C0700X
CA314942163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse