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General NPI Number Information
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NPI Number | 1003147232
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Entity Type | Organization
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Legal Business Name | DALE W. FABER, LCSW, P.C.
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 1035 GROVE ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-4636
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Country | US
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Telephone | 630-926-4873
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Fax | 630-852-6335
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Provider Business Mailing Address
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Address Line | 1035 GROVE ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-4636
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Country | US
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Telephone | 630-926-4873
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Fax | 630-852-6335
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Authorized Official
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Title or Position | OWNER
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Name | DR. DALE W FABER
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Credential | LCSW, PH.D. M.DIV.
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Telephone | 630-926-4873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 149-008480
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 149-008480
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License Number State | IL
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