Provider Demographics
NPI:1053484519
Name:MITCHELL FADIL, VALERIE ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:ANNE
Last Name:MITCHELL FADIL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 VALLEY RD
Mailing Address - Street 2:# F8
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-4042
Mailing Address - Country:US
Mailing Address - Phone:973-725-0616
Mailing Address - Fax:973-773-0413
Practice Address - Street 1:497 BROADWAY
Practice Address - Street 2:SUITE C
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3710
Practice Address - Country:US
Practice Address - Phone:973-725-0616
Practice Address - Fax:973-773-0413
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical