Healthcare Provider Details

I. General information

NPI: 1558787564
Provider Name (Legal Business Name): JOANNE FADOOL MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HIGHLAND AVE
HADDON TOWNSHIP NJ
08108-2634
US

IV. Provider business mailing address

3 CRANBURY HILL COURT
MOUNT LAUREL NJ
08054
US

V. Phone/Fax

Practice location:
  • Phone: 856-854-3155
  • Fax:
Mailing address:
  • Phone: 609-828-0097
  • Fax: 856-802-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC0557600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: