Healthcare Provider Details

I. General information

NPI: 1659140671
Provider Name (Legal Business Name): CONNIE FAZZIO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W COMMONS BLVD STE 301
NEW CASTLE DE
19720-2419
US

IV. Provider business mailing address

100 W COMMONS BLVD STE 301
NEW CASTLE DE
19720-2419
US

V. Phone/Fax

Practice location:
  • Phone: 302-224-1400
  • Fax: 302-224-1402
Mailing address:
  • Phone: 302-224-1400
  • Fax: 302-224-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberQ3-0011307
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: