Healthcare Provider Details

I. General information

NPI: 1154169183
Provider Name (Legal Business Name): FAF SOLUTIONS & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 FORT HALE RD
NEW HAVEN CT
06512-3603
US

IV. Provider business mailing address

110 FORT HALE RD
NEW HAVEN CT
06512-3603
US

V. Phone/Fax

Practice location:
  • Phone: 203-641-6768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: FRANCIS FISCO
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 203-641-6768