Individual
MS. AMANDA WAGERIK-FASANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW, CASAC-T
Contact information
Practice address
3911 RICHMOND AVE, STATEN ISLAND, NY 10312-5110
(718) 948-3232
(718) 966-6605
Mailing address
3911 RICHMOND AVE, STATEN ISLAND, NY 10312-5110
(718) 948-3232
(718) 966-6605
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
12/12/2011
Last updated
05/08/2019
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