Provider Demographics
NPI:1346452968
Name:FACCHINI, AIMEE THERESA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:AIMEE
Middle Name:THERESA
Last Name:FACCHINI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:YARMOUTHPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675
Mailing Address - Country:US
Mailing Address - Phone:508-360-8578
Mailing Address - Fax:508-630-9006
Practice Address - Street 1:3179 MAIN ST
Practice Address - Street 2:UNIT 3
Practice Address - City:BARNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:02630
Practice Address - Country:US
Practice Address - Phone:508-360-8578
Practice Address - Fax:508-630-9006
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110947104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAFAP23353Medicare ID - Type Unspecified