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General NPI Number Information
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NPI Number | 1023649621
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Entity Type | Organization
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Legal Business Name | DANI FAZIO PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 02/01/2020
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 57 EXCHANGE ST STE 203
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City | PORTLAND
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State | ME
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Zip | 04101-5000
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Country | US
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Telephone | 207-618-6588
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Fax | 207-203-6480
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Provider Business Mailing Address
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Address Line | 57 EXCHANGE ST STE 203
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City | PORTLAND
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State | ME
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Zip | 04101-5000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER; CLINICIAN
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Name | DANIELLE FAZIO
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Credential | LCSW, CADC
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Telephone | 207-618-6588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | NULL
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