Provider Demographics
NPI:1255493359
Name:COOK-FASANO, HAZEL T (LCSW-C)
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:T
Last Name:COOK-FASANO
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:HAZEL
Other - Middle Name:T
Other - Last Name:COOK-FASANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:100 N DUPONT RD
Mailing Address - Street 2:ROOM 238
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-3106
Mailing Address - Country:US
Mailing Address - Phone:302-651-2100
Mailing Address - Fax:302-651-2111
Practice Address - Street 1:100 N DUPONT RD
Practice Address - Street 2:ROOM 238
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807-3106
Practice Address - Country:US
Practice Address - Phone:302-651-2100
Practice Address - Fax:302-651-2111
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD109361041C0700X
DEQ1-00011531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical