Provider Demographics
NPI:1003610163
Name:DEFALCO, BRE'ANNA FAY
Entity type:Individual
Prefix:
First Name:BRE'ANNA
Middle Name:FAY
Last Name:DEFALCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NJ-168
Mailing Address - Street 2:G3
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012
Mailing Address - Country:US
Mailing Address - Phone:856-373-1744
Mailing Address - Fax:
Practice Address - Street 1:900 NJ-168
Practice Address - Street 2:G3
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-302-5728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00684500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional