Provider Demographics
NPI:1437165859
Name:FASK, SYLVIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:
Last Name:FASK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ASH LN
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4757
Mailing Address - Country:US
Mailing Address - Phone:973-895-5180
Mailing Address - Fax:973-895-5478
Practice Address - Street 1:10 ASH LN
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-4757
Practice Address - Country:US
Practice Address - Phone:973-895-5180
Practice Address - Fax:973-895-5478
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00236800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist