Provider Demographics
NPI:1679238836
Name:FORNOFF, LEA (MSW)
Entity Type:Individual
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First Name:LEA
Middle Name:
Last Name:FORNOFF
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Gender:F
Credentials:MSW
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Mailing Address - Street 1:1929 LINCOLN HWY E STE 100
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-3347
Mailing Address - Country:US
Mailing Address - Phone:717-397-7625
Mailing Address - Fax:717-397-6057
Practice Address - Street 1:1929 LINCOLN HWY E STE 100
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-3347
Practice Address - Country:US
Practice Address - Phone:717-397-7625
Practice Address - Fax:717-397-6057
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
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