Carly Marie Fazio, LCSW, LCADC

Primary specialty

Social WorkerTaxonomy code 104100000X

License

44SL06278200 Issued in NJ

Practice address

18 Kings Hwy Ste 100
Middletown, NJ 07748-2509

Phone

(732) 359-2212

NPI assigned

Sep 15, 2017

Reactivated

May 13, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brodsky Wellness LLC

  • Mental Health Counselor
  • Middletown, NJ
  • NPI 1679154165
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1639698111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 KINGS HWY STE 100",
            "city": "MIDDLETOWN",
            "state": "NJ",
            "postal_code": "077482509",
            "telephone_number": "732-359-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 KINGS HWY STE 100",
            "city": "MIDDLETOWN",
            "state": "NJ",
            "postal_code": "077482509",
            "telephone_number": "732-359-2212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "166 Main St",
            "address_purpose": "LOCATION",
            "city": "Matawan",
            "state": "NJ",
            "postal_code": "077473104",
            "country_code": "US",
            "telephone_number": "732-290-9040 x441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAZIO",
        "first_name": "CARLY",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LCSW, LCADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-15",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "deactivation_date": "2021-04-16",
        "reactivation_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "44SL06278200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard W Elsinger, D.M.D.
• Emo Medical Care LLC
• Dalene Cheek Evans, PA-C
• Family Community Medicine LLC
• Family Wellness Center PC
• Jacqueline E Feinberg, M.D.
• Emmet Theodore Fenichel, M.D.
• Emily E Ferejohn, LMT
• Tara Ferejohn, LCSW
• Lauren Fernandez, BCBA

• Social Worker in Middletown, NJ
• Providers in Middletown, NJ by specialty
• Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.