Basic Information
| Provider Information | |||||||||
| NPI: | 1003011552 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FINGERHUT | ||||||||
| FirstName: | RANDY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 E LANCASTER AVE | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | WYNNEWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190962139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159511284 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 E LANCASTER AVE | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | WYNNEWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190962139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159511284 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | PS-009165-L | PA | X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | PS-009165-L | PA | X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.