Provider Demographics
NPI:1184237091
Name:DIFABRIZIO, ANDREA DAWN (LPC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DAWN
Last Name:DIFABRIZIO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SAGAMORE RD
Mailing Address - Street 2:
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874-2813
Mailing Address - Country:US
Mailing Address - Phone:973-641-2418
Mailing Address - Fax:
Practice Address - Street 1:40 BALDWIN RD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2986
Practice Address - Country:US
Practice Address - Phone:973-316-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00724300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional