Provider Demographics
NPI:1194052423
Name:FAZIO, LINDA FRANCES (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:FRANCES
Last Name:FAZIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WOODY LN
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3252
Mailing Address - Country:US
Mailing Address - Phone:631-754-2235
Mailing Address - Fax:
Practice Address - Street 1:16 WOODY LN
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3252
Practice Address - Country:US
Practice Address - Phone:631-754-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007956-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist