Individual
JOSANDRA DEFAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LGSW
Contact information
Practice address
65 PROFESSIONAL PL STE 102, BRIDGEPORT, WV 26330-0259
(304) 848-5770
(304) 848-5477
Mailing address
65 PROFESSIONAL PL STE 102, BRIDGEPORT, WV 26330-0259
(304) 848-5770
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
DP00946344
WV
Other
Enumeration date
09/15/2022
Last updated
12/09/2025
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