| Doctor Name: | CLARISSA A FAVICHIA |
| NPI Number: | 1053788190 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | 006740 |
| Business Practice Address: | 1380 Roanoke Ave 1st Floor Riverhead, NY - 119012098 |
| Business Phone Number: | 6313690022 |
| Business Fax Number: | 6313695336 |
| Mailing Address: | 355 Woodland Ave, MANORVILLE |
| State: | NY |
| Postal Code: | 119492051 |
| Phone Number: | 6313322008 |
| Fax Number: | |
| NPI Enumeration Date: | 08/24/2015 |
| NPI Last Update Date: | 09/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 006740 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |