Healthcare Provider Details

I. General information

NPI: 1376765230
Provider Name (Legal Business Name): RANDY CAROL FAERBER L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RANDY BUCKINGHAM SOCIAL WORKER/CLINIC

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 EAST 69TH STREET
NEW YORK NY
10021-5437
US

IV. Provider business mailing address

300 EAST 71ST STREET
NEW YORK NY
10021
US

V. Phone/Fax

Practice location:
  • Phone: 917-848-4065
  • Fax: 212-986-0997
Mailing address:
  • Phone: 212-972-9884
  • Fax: 212-986-0997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR032810
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: