Provider Demographics
NPI:1912155342
Name:FAZIO, STACY ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:ELIZABETH
Last Name:FAZIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ELMER AVE
Mailing Address - Street 2:
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-1825
Mailing Address - Country:US
Mailing Address - Phone:973-637-0213
Mailing Address - Fax:
Practice Address - Street 1:10 ELMER AVE
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-1825
Practice Address - Country:US
Practice Address - Phone:973-637-0213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0781991041C0700X
NJ44SC055898001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical