Individual
BRIAN FAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
QMHA, CADC
Contact information
Practice address
811 MUSKET CT, LACKAWAXEN, PA 18435-7802
(570) 229-5744
Mailing address
811 MUSKET CT, LACKAWAXEN, PA 18435-7802
(570) 229-5744
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18759
PA
101YM0800X
Mental Health Counselor
BH007954
PA
Other
Enumeration date
08/29/2023
Last updated
01/10/2026
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