Provider Demographics
NPI:1831203579
Name:FANTAUZZO, CHRISTINA (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:FANTAUZZO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1082 TAYLORSVILLE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON CROSSING
Mailing Address - State:PA
Mailing Address - Zip Code:18977-1305
Mailing Address - Country:US
Mailing Address - Phone:267-291-4263
Mailing Address - Fax:267-361-1176
Practice Address - Street 1:1082 TAYLORSVILLE RD STE 210
Practice Address - Street 2:
Practice Address - City:WASHINGTON CROSSING
Practice Address - State:PA
Practice Address - Zip Code:18977-1305
Practice Address - Country:US
Practice Address - Phone:267-291-4263
Practice Address - Fax:267-361-1176
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ355100658400103TC0700X
PAPS008893L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0920921OtherHIGHMARK BLUE SHIELD
0920921OtherHIGHMARK BLUE SHIELD