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NPI Code Detail

MEDICARE: MANDY ANN FAUBLE LCSW

MEDICARE: MANDY ANN FAUBLE LCSW
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 WorkerCW014906PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1001679712OTHERPAHIGHMARK
2467400OTHERPAVALUEOPTIONS
3530903-000OTHERPAMAGELLANE
47717663OTHERPAAETNA

General Provider Information

NPI Number : 1134100258
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANDY ANN FAUBLE LCSW
Provider Business Mailing Address
First Line : 1330 W 26TH ST
Second Line :
City : ERIE
State : PA
Zip : 16508-1402
Country : US
Telephone Number : 814-459-9300
Fax Number : 814-454-7780
Provider Business Practice Location Address
First Line : 1330 W 26TH ST
Second Line :
City : ERIE
State : PA
Zip : 16508-1402
Country : US
Telephone Number : 814-459-9300
Fax Number : 814-454-7780
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 03/15/2021

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