Healthcare Provider Details

I. General information

NPI: 1871161661
Provider Name (Legal Business Name): AUBREY ELIZABETH FAGGEN LMSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 REMSEN ST FL 4
BROOKLYN NY
11201-4300
US

IV. Provider business mailing address

642 10TH AVE APT 4S
NEW YORK NY
10036-3077
US

V. Phone/Fax

Practice location:
  • Phone: 212-273-6182
  • Fax:
Mailing address:
  • Phone: 610-608-7124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06668100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number113911
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: