1952883258 NPI number — BARBARA J FASULO LCSW

Table of content: BARBARA J FASULO LCSW (NPI 1952883258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952883258 NPI number — BARBARA J FASULO LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FASULO
Provider First Name:
BARBARA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952883258
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
59 CLUBHOUSE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROMWELL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06416-2565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-416-5288
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 SMITH ST STE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06457-1594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-416-5288
Provider Business Practice Location Address Fax Number:
866-085-6008
Provider Enumeration Date:
09/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  11785 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11785 . This is a "LCSW" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com