Provider Demographics
NPI:1396048823
Name:FASOLO, MARGARET GRACE (LMSW)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:GRACE
Last Name:FASOLO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 STRATHMORE RD
Mailing Address - Street 2:#4
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5201
Mailing Address - Country:US
Mailing Address - Phone:914-207-9019
Mailing Address - Fax:
Practice Address - Street 1:149 STRATHMORE RD
Practice Address - Street 2:#4
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-5201
Practice Address - Country:US
Practice Address - Phone:914-207-9019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-05
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081787-1104100000X
MA1191821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker