Individual
EILEEN ANNE FASANELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2 WOODMONT RD, MONTCLAIR, NJ 07043-2500
(973) 818-2164
Mailing address
2 WOODMONT RD, MONTCLAIR, NJ 07043-2500
(973) 818-2164
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
41YS00206300
NJ
Other
Enumeration date
03/31/2021
Last updated
03/31/2021
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