Provider Demographics
NPI:1215608864
Name:FACCIOLO, PJ (MSW, LSSW)
Entity type:Individual
Prefix:
First Name:PJ
Middle Name:
Last Name:FACCIOLO
Suffix:
Gender:F
Credentials:MSW, LSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16287 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-3614
Mailing Address - Country:US
Mailing Address - Phone:302-703-6332
Mailing Address - Fax:302-827-4856
Practice Address - Street 1:16287 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3614
Practice Address - Country:US
Practice Address - Phone:302-643-2011
Practice Address - Fax:302-827-4856
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical