Organization
ANTHONY DEFAZIO, LCADC LLC
Active
Other names
Anthony DeFazio, LCADC LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY J DEFAZIO LCADC (OWNER)
(173) 298-4126
Entity
Organization
Contact information
Practice address
1540 RTE 138 STE 201, WALL, NJ 07719-3765
(732) 984-1263
(732) 515-9159
Mailing address
1540 RTE 138 STE 201, WALL, NJ 07719-3765
(732) 984-1263
(732) 515-9159
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
10/19/2023
Last updated
10/19/2023
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