Provider Demographics
NPI:1801123443
Name:FRABIZZIO, MARIO J JR (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:J
Last Name:FRABIZZIO
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:128 FAIRFAX BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3025
Mailing Address - Country:US
Mailing Address - Phone:302-654-9720
Mailing Address - Fax:302-654-9720
Practice Address - Street 1:3411 SILVERSIDE RD
Practice Address - Street 2:CONCORD PLAZA 206 BAYNARD BLDG
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4812
Practice Address - Country:US
Practice Address - Phone:302-479-5151
Practice Address - Fax:302-654-9720
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000601103TC0700X
PAPS003665L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical