MEDICARE: EMILY MARIE FATALI LCSW

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	104100000X	Social Worker	113056563502	UT

General Provider Information

NPI Number	:	1861049678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MARIE FATALI LCSW

Provider Business Mailing Address
First Line	:	963 W DEBONAIR DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-2120
Country	:	US
Telephone Number	:	913-424-5756
Fax Number	:

Provider Business Practice Location Address
First Line	:	2655 S LAKE ERIE DR STE B
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-7351
Country	:	US
Telephone Number	:	801-608-5750
Fax Number	:

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

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	01/15/2026

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