Provider Demographics
NPI:1649902636
Name:FADEY, LAMARILYN
Entity type:Individual
Prefix:
First Name:LAMARILYN
Middle Name:
Last Name:FADEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 JASMINE LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6814
Mailing Address - Country:US
Mailing Address - Phone:806-535-0833
Mailing Address - Fax:
Practice Address - Street 1:4320 JASMINE LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6814
Practice Address - Country:US
Practice Address - Phone:806-535-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency