Healthcare Provider Details

I. General information

NPI: 1679436141
Provider Name (Legal Business Name): ANDREA VICTORIA FAIA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PERKINS RD
MIDDLETON MA
01949-2223
US

IV. Provider business mailing address

10 PERKINS RD
MIDDLETON MA
01949-2223
US

V. Phone/Fax

Practice location:
  • Phone: 978-998-5156
  • Fax:
Mailing address:
  • Phone: 978-998-5156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberFAIA-ZY8Q3V
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: