Healthcare Provider Details

I. General information

NPI: 1376944900
Provider Name (Legal Business Name): DEBRA SUE FAECHER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E 71ST ST SUITE 1B
NEW YORK NY
10021-5274
US

IV. Provider business mailing address

330 E 71ST ST SUITE 1B
NEW YORK NY
10021-5274
US

V. Phone/Fax

Practice location:
  • Phone: 917-536-8571
  • Fax:
Mailing address:
  • Phone: 917-536-8571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR059640-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: