Provider Demographics
NPI:1578435368
Name:FASANO, CHELSEA LEIGH
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LEIGH
Last Name:FASANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 COVERT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-2377
Mailing Address - Country:US
Mailing Address - Phone:917-935-8849
Mailing Address - Fax:
Practice Address - Street 1:7 COVERT ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-2377
Practice Address - Country:US
Practice Address - Phone:917-935-8849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP136921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health