Provider Demographics
NPI:1215409040
Name:FASCIANO, STEPHANIE (MS)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:FASCIANO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-1812
Mailing Address - Country:US
Mailing Address - Phone:860-225-4641
Mailing Address - Fax:860-225-4642
Practice Address - Street 1:586 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-1812
Practice Address - Country:US
Practice Address - Phone:860-225-4641
Practice Address - Fax:860-225-4642
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor