Provider Demographics
NPI:1770205312
Name:FABRIZIO, CRYSTAL (LPC, LCADC,CCTP,CCS)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:FABRIZIO
Suffix:
Gender:F
Credentials:LPC, LCADC,CCTP,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 GALLOWAY RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9606
Mailing Address - Country:US
Mailing Address - Phone:609-993-3965
Mailing Address - Fax:
Practice Address - Street 1:505 NEW RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1609
Practice Address - Country:US
Practice Address - Phone:609-992-3965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00872300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional