Provider Demographics
NPI:1710259601
Name:FIORELLO, JOHN MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:FIORELLO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 SKYLINE LAKES DR
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-1960
Mailing Address - Country:US
Mailing Address - Phone:973-727-2217
Mailing Address - Fax:
Practice Address - Street 1:546 HIGH MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2606
Practice Address - Country:US
Practice Address - Phone:973-727-2217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00399400103TC0700X
NY014623-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical