Provider Demographics
NPI:1326415704
Name:FENSTERMAKER, HEATHER LYNNE (MED, BCBA, LBS)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LYNNE
Last Name:FENSTERMAKER
Suffix:
Gender:F
Credentials:MED, BCBA, LBS
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:LYNNE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, BCBA, LBS
Mailing Address - Street 1:103 W GARDNER AVE
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1816
Mailing Address - Country:US
Mailing Address - Phone:267-255-4261
Mailing Address - Fax:
Practice Address - Street 1:1553 CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:CRUM LYNNE
Practice Address - State:PA
Practice Address - Zip Code:19022-1022
Practice Address - Country:US
Practice Address - Phone:215-645-5408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-15-18308103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst