Provider Demographics
NPI:1518173814
Name:FARIELLO, CHRISTOPHER F (PHD, MA, LMFT)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:F
Last Name:FARIELLO
Suffix:
Gender:M
Credentials:PHD, MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHIPMUNK LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4708
Mailing Address - Country:US
Mailing Address - Phone:215-382-6680
Mailing Address - Fax:
Practice Address - Street 1:4025 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3054
Practice Address - Country:US
Practice Address - Phone:215-382-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000278106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMF000278OtherMFT LICENSE