MEDICARE: EMILY FABER LCSW PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1467238238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMILY FABER LCSW PLLC

Provider Business Mailing Address
First Line	:	2720 HOMESTEAD RD STE 220
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-4881
Country	:	US
Telephone Number	:	435-709-6247
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 HOMESTEAD RD STE 220
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-4881
Country	:	US
Telephone Number	:	435-709-6247
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EMILY FABER
Credential	:	LCSW
Telephone Number	:	801-699-0668

Provider Enumeration Date	:	09/06/2023
Last Update Date	:	03/19/2024

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