Individual
SUSAN FASULO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
250 ARSENAL ST, STATE HOUSE STATION 11, AUGUSTA, ME 04330-5742
(207) 215-9079
Mailing address
250 ARSENAL ST, STATE HOUSE STATION 11, AUGUSTA, ME 04330-5742
(207) 215-9079
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC14158
ME
Other
Enumeration date
07/18/2014
Last updated
09/04/2014
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