Provider Demographics
NPI:1649497520
Name:FAZIO, MELISSA MARY MORIARTY (MSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARY MORIARTY
Last Name:FAZIO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1661
Mailing Address - Country:US
Mailing Address - Phone:978-304-0426
Mailing Address - Fax:
Practice Address - Street 1:203 LOCUST ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1661
Practice Address - Country:US
Practice Address - Phone:978-304-0426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0719121041C0700X
MA1141851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical