Provider Demographics
NPI:1861085011
Name:MARIO J FRABIZZIO JR, PHD LICENSED PSYCHOLOGIST
Entity type:Organization
Organization Name:MARIO J FRABIZZIO JR, PHD LICENSED PSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRABIZZIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:302-479-5151
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:302-593-4823
Mailing Address - Fax:302-654-9720
Practice Address - Street 1:202 WEBSTER BLDG CONCORD PLAZA
Practice Address - Street 2:3411 SILVERSIDE RD
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty