Provider Demographics
NPI:1871811463
Name:GREENFIELD, FAWN K (MSW, CAC)
Entity type:Individual
Prefix:
First Name:FAWN
Middle Name:K
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:MSW, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 SAGAMORE HL
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-1168
Mailing Address - Country:US
Mailing Address - Phone:717-977-1635
Mailing Address - Fax:
Practice Address - Street 1:100 N CAMERON ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2424
Practice Address - Country:US
Practice Address - Phone:717-232-2946
Practice Address - Fax:717-238-7894
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)