Healthcare Provider Details

I. General information

NPI: 1043117955
Provider Name (Legal Business Name): DANIEL FASSIO PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2026
Last Update Date: 10/23/2026
Certification Date: 10/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 ELM ST STE 507
MC LEAN VA
22101-3859
US

IV. Provider business mailing address

13896 FERRARA CT
CHANTILLY VA
20151-2322
US

V. Phone/Fax

Practice location:
  • Phone: 703-215-4101
  • Fax:
Mailing address:
  • Phone: 202-823-2603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810009569
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: