Provider Demographics
NPI:1871762237
Name:FAZLI-HAQ, ANEEZA (LCSW)
Entity type:Individual
Prefix:
First Name:ANEEZA
Middle Name:
Last Name:FAZLI-HAQ
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 1:925 MASTERS WAY
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2186
Mailing Address - Country:US
Mailing Address - Phone:215-764-6788
Mailing Address - Fax:
Practice Address - Street 1:400 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2414
Practice Address - Country:US
Practice Address - Phone:215-368-2022
Practice Address - Fax:215-855-6454
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2016-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0157691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102007451Medicaid