=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801234505
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN WILLIAM FAAS LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2013
-----------------------------------------------------
Last Update Date | 06/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23560 LYONS AVE # 204
-----------------------------------------------------
City | NEWHALL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91321-2513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-799-7994
-----------------------------------------------------
Fax | 661-287-9705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23638 LYONS AVE # 214
-----------------------------------------------------
City | NEWHALL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91321-2513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-799-7994
-----------------------------------------------------
Fax | 661-287-9705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCS11560
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------