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General NPI Number Information
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NPI Number | 1104261544
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Entity Type | Individual
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Provider Name | STACY LYNN FAZIO LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 08/28/2022
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Provider Practice Location Address
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Address Line | 755 N PEACH AVE STE H14
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City | CLOVIS
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State | CA
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Zip | 93611-7264
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Country | US
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Telephone | 555-999-7308
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Fax | 559-712-6282
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Provider Business Mailing Address
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Address Line | 673 W RICHMOND AVE
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City | CLOVIS
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State | CA
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Zip | 93619-4825
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Country | US
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Telephone | 555-999-7308
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Fax | 559-712-6282
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW19354
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License Number State | CA
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