Individual
LITA MARIA FASANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.M.
Contact information
Practice address
40 ARMINGTON ST, ALLSTON, MA 02134-2406
(617) 635-8534
Mailing address
40 ARMINGTON ST, ALLSTON, MA 02134-2406
(617) 635-8534
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
264106
MA
Other
Enumeration date
10/01/2018
Last updated
10/01/2018
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