=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861085011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARIO J FRABIZZIO JR, PHD LICENSED PSYCHOLOGIST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2021
-----------------------------------------------------
Last Update Date | 02/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 WEBSTER BLDG CONCORD PLAZA 3411 SILVERSIDE RD
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19810-4812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-479-5151
-----------------------------------------------------
Fax | 302-654-9720
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 128 FAIRFAX BLVD
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19803-3025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-593-4823
-----------------------------------------------------
Fax | 302-654-9720
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. MARIO J FRABIZZIO JR.
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 302-479-5151
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------