Individual provider Active NPI

Maura Lee Pantone Fascetti, PSYD

  • Clinical Psychologist
  • Lancaster, PA
National Provider Identifier
1457902686
Registry record updated Sep 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS018859 Issued in PA
Practice address
410 N Prince St
Lancaster, PA 17603-3010
Phone
(717) 560-7917
Fax
(717) 560-6452
NPI assigned
Sep 29, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PS018859 PA Primary

Addresses

Primary practice location

410 N Prince St
Lancaster, PA 17603-3010

Mailing address

410 N Prince St
Lancaster, PA 17603-3010
Phone (717) 560-7917

Other names 1

  • Maura Lee Pantone Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191114002271 PA Practitioner - Clinical Psychologist 5597197400 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PS018859PAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
T.W. Ponessa & Associates Counseling Services, Inc. CurrentSince Oct 22, 2019 Accepting new patients

Locations

410 N Prince St
Lancaster, PA 17603

15 S 9th St
Lebanon, PA 17042
Phone (717) 273-5992

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569715200000",
    "number": "1457902686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 N PRINCE ST",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176033010",
            "telephone_number": "717-560-7917",
            "fax_number": "717-560-6452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 N PRINCE ST",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176033010",
            "telephone_number": "717-560-7917",
            "fax_number": "717-560-6452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FASCETTI",
        "first_name": "MAURA",
        "middle_name": "LEE PANTONE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-29",
        "last_updated": "2019-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS018859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAURA",
            "last_name": "PANTONE",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lancaster, PA

Sources for this page

Verify at the official NPI Registry.