Healthcare Provider Details

I. General information

NPI: 1003147232
Provider Name (Legal Business Name): DALE W. FABER, LCSW, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 GROVE ST
DOWNERS GROVE IL
60515-4636
US

IV. Provider business mailing address

1035 GROVE ST
DOWNERS GROVE IL
60515-4636
US

V. Phone/Fax

Practice location:
  • Phone: 630-926-4873
  • Fax: 630-852-6335
Mailing address:
  • Phone: 630-926-4873
  • Fax: 630-852-6335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number149-008480
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number149-008480
License Number StateIL

VIII. Authorized Official

Name: DR. DALE W FABER
Title or Position: OWNER
Credential: LCSW, PH.D. M.DIV.
Phone: 630-926-4873