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NPI Code Detail

MEDICARE: STEPHANIE JO FABER LICSW

MEDICARE: STEPHANIE JO FABER LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker16573MN

General Provider Information

NPI Number : 1023384112
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE JO FABER LICSW
Provider Business Mailing Address
First Line : 1201 HARMON PLACE
Second Line : STE 103
City : MPLS
State : MN
Zip : 55403
Country : US
Telephone Number : 612-313-3240
Fax Number : 612-338-5902
Provider Business Practice Location Address
First Line : 1606 WASHINGTON ST NE # 2
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-1336
Country : US
Telephone Number : 763-221-9084
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2012
Last Update Date : 08/29/2013

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