MEDICARE: MS. JULIET E FABER LMSW

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
1	104100000X	Social Worker	090688-1	NY

General Provider Information

NPI Number	:	1275944431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIET E FABER LMSW

Provider Business Mailing Address
First Line	:	2490 FREDERICK DOUGLASS BLVD
Second Line	:	APT. 4A
City	:	NEW YORK
State	:	NY
Zip	:	10030-2792
Country	:	US
Telephone Number	:	212-203-7345
Fax Number	:

Provider Business Practice Location Address
First Line	:	2490 FREDERICK DOUGLASS BLVD
Second Line	:	APT. 4A
City	:	NEW YORK
State	:	NY
Zip	:	10030-2792
Country	:	US
Telephone Number	:	212-203-7345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2014
Last Update Date	:	05/09/2014

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