Individual
ANTHONY DEFAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
1540 RTE 138 STE 202, WALL, NJ 07719-3765
(732) 984-1263
(732) 515-9159
Mailing address
1540 RT 138 SUITE 202, WALL, NJ 07719
(732) 984-1263
(732) 515-9159
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
05/27/2016
Last updated
03/07/2017
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