MEDICARE: MARISSA FAZIO-HAERING LMHC, CRC, CASAC

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	000560	NY

General Provider Information

NPI Number	:	1265954176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA FAZIO-HAERING LMHC, CRC, CASAC

Provider Business Mailing Address
First Line	:	672 DOGWOOD AVE # 123
Second Line	:
City	:	FRANKLIN SQUARE
State	:	NY
Zip	:	11010-3247
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	672 DOGWOOD AVE # 123
Second Line	:
City	:	FRANKLIN SQUARE
State	:	NY
Zip	:	11010-3247
Country	:	US
Telephone Number	:	516-712-2562
Fax Number	:

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

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	12/05/2022

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