| Mary Ellen Fassnacht | |
|
1250 Rte 23 Butler NJ 07405-2037 | |
| (973) 722-9831 | |
| Not Available |
| Full Name | Mary Ellen Fassnacht |
|---|---|
| Speciality | Social Worker |
| Location | 1250 Rte 23, Butler, New Jersey |
| Authorized Official Name and Position | Mary Ellen Fassnacht (OWNER/PROVIDER) |
| Authorized Official Contact | 9737229831 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Ellen Fassnacht 317 Godwin Ave Midland Park NJ 07432-1519 Ph: () - | Mary Ellen Fassnacht 1250 Rte 23 Butler NJ 07405-2037 Ph: (973) 722-9831 |
| NPI Number | 1013564079 |
|---|---|
| Provider Enumeration Date | 08/23/2019 |
| Last Update Date | 08/23/2019 |
| Medicare PECOS PAC ID | 3577893841 |
|---|---|
| Medicare Enrollment ID | O20190930001631 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013564079 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Mary Ellen Fassnacht |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245703909 PECOS PAC ID: 4486984754 Enrollment ID: I20190930002305 |
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