Provider Demographics
NPI:1891549291
Name:FORTNEY, AUDREY PASCALE (LCSW)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:PASCALE
Last Name:FORTNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:PASCALE
Other - Last Name:DEVAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1209 CARRIAGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-1621
Mailing Address - Country:US
Mailing Address - Phone:860-941-2048
Mailing Address - Fax:
Practice Address - Street 1:1209 CARRIAGE HILL DR
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-1621
Practice Address - Country:US
Practice Address - Phone:860-941-2048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0241821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical