| Dani Fazio Psychotherapy Llc | |
|
57 Exchange St Ste 203 Portland ME 04101-5000 | |
| (207) 618-6588 | |
| (207) 203-6480 |
| Full Name | Dani Fazio Psychotherapy Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 57 Exchange St Ste 203, Portland, Maine |
| Authorized Official Name and Position | Danielle Fazio (OWNER; CLINICIAN) |
| Authorized Official Contact | 2076186588 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dani Fazio Psychotherapy Llc 57 Exchange St Ste 203 Portland ME 04101-5000 Ph: () - | Dani Fazio Psychotherapy Llc 57 Exchange St Ste 203 Portland ME 04101-5000 Ph: (207) 618-6588 |
| NPI Number | 1023649621 |
|---|---|
| Provider Enumeration Date | 02/01/2020 |
| Last Update Date | 02/01/2020 |
| Certification Date | 02/01/2020 |
| Medicare PECOS PAC ID | 0941696942 |
|---|---|
| Medicare Enrollment ID | O20220330002603 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023649621 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Danielle Y Fazio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194240598 PECOS PAC ID: 0244562114 Enrollment ID: I20191025000287 |
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