Healthcare Provider Details

I. General information

NPI: 1780045922
Provider Name (Legal Business Name): ANDRIA MAGLIOZZI FUSCO L.A.C, NBCC,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 MORNINGSIDE RD
PARAMUS NJ
07652-1600
US

IV. Provider business mailing address

138 MORNINGSIDE RD
PARAMUS NJ
07652-1600
US

V. Phone/Fax

Practice location:
  • Phone: 908-451-1150
  • Fax:
Mailing address:
  • Phone: 908-451-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00176400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: