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NPI Code Detail

MEDICARE: KAREN SIMMONS-FABER PHD

MEDICARE: KAREN SIMMONS-FABER PHD
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
1103TC2200XClinical Child & Adolescent Psychologist0810002112VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10810002112OTHERVALIC

General Provider Information

NPI Number : 1134129422
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN SIMMONS-FABER PHD
Provider Business Mailing Address
First Line : 1147 INDEPENDENCE BLVD
Second Line : FAMILY MEDICAL PRACTITIONERS
City : VIRGINIA BEACH
State : VA
Zip : 23455-5545
Country : US
Telephone Number : 757-460-1207
Fax Number : 757-460-2136
Provider Business Practice Location Address
First Line : 1147 INDEPENDENCE BLVD
Second Line : FAMILY MEDICAL PRACTITIONERS
City : VIRGINIA BEACH
State : VA
Zip : 23455-5545
Country : US
Telephone Number : 757-460-1207
Fax Number : 757-460-2136
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 07/08/2007

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