Provider Demographics
NPI:1457902686
Name:FASCETTI, MAURA LEE PANTONE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MAURA
Middle Name:LEE PANTONE
Last Name:FASCETTI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MAURA
Other - Middle Name:LEE
Other - Last Name:PANTONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 N PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3010
Mailing Address - Country:US
Mailing Address - Phone:717-560-7917
Mailing Address - Fax:717-560-6452
Practice Address - Street 1:410 N PRINCE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3010
Practice Address - Country:US
Practice Address - Phone:717-560-7917
Practice Address - Fax:717-560-6452
Is Sole Proprietor?:No
Enumeration Date:2019-09-29
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018859103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical