Provider Demographics
NPI:1639665714
Name:FATTIZZI, MEAGHAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MEAGHAN
Middle Name:
Last Name:FATTIZZI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MEAGHAN
Other - Middle Name:
Other - Last Name:STACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8200 HENRY AVE APT G15
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2960
Mailing Address - Country:US
Mailing Address - Phone:732-597-3433
Mailing Address - Fax:
Practice Address - Street 1:2935 BYBERRY RD STE 108
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-2831
Practice Address - Country:US
Practice Address - Phone:215-957-9771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0202411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical