Amy Fantalis | Media, PA • PECOS Search

Amy Fantalis

Social Worker

Behavioral Health & Social Service Providers

42 E Front St, Media, PA 19063-2912

PECOS Enrollment

Based on the most recent information from CMS, provider Amy Fantalis does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1316285505
Provider Type
Individual
Full Name
Fantalis, Amy
Credential
MS, MSW, LCSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
1/22/2013
Last Updated
1/22/2013

Contact Information

Practice Location

42 E Front St, Media, PA 19063-2912

Unlisted Fax

Mailing Location

42 E Front St, Media, PA 19063-2912

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License CW012471 Pennsylvania