Provider Demographics
NPI:1649756412
Name:TURNER, FAWN SUSANNE
Entity Type:Individual
Prefix:
First Name:FAWN
Middle Name:SUSANNE
Last Name:TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FAWN
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3717 BOSTON ST # 148
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5752
Mailing Address - Country:US
Mailing Address - Phone:443-800-3301
Mailing Address - Fax:
Practice Address - Street 1:3717 BOSTON ST # 148
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5752
Practice Address - Country:US
Practice Address - Phone:443-800-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician