Provider Demographics
NPI:1336766286
Name:FASANO, MEGHAN (LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:FASANO
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:BARCELLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-1333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:213 HEMPSTEAD AVE UNIT A
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1656
Practice Address - Country:US
Practice Address - Phone:516-256-9523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty