Provider Demographics
NPI:1558485185
Name:DEFAZIO, DONNA MARIE
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:DEFAZIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 CALIFORNIA TER
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2450
Mailing Address - Country:US
Mailing Address - Phone:626-795-7958
Mailing Address - Fax:626-795-7710
Practice Address - Street 1:453 CALIFORNIA TER
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2450
Practice Address - Country:US
Practice Address - Phone:626-795-7958
Practice Address - Fax:626-795-7710
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool