MEDICARE: ANGEL FAZIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1164957775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL FAZIO

Provider Business Mailing Address
First Line	:	307 WALDEN WAY
Second Line	:
City	:	IMPERIAL
State	:	PA
Zip	:	15126-9639
Country	:	US
Telephone Number	:	724-263-3920
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 WALDEN WAY
Second Line	:
City	:	IMPERIAL
State	:	PA
Zip	:	15126-9639
Country	:	US
Telephone Number	:	724-263-3920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2017
Last Update Date	:	03/12/2026

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Directions to “ ANGEL FAZIO ” Practice Location

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