MEDICARE: LEORE J FABER PSYD

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	103TC0700X	Clinical Psychologist	022393	NY

General Provider Information

NPI Number	:	1306352356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEORE J FABER PSYD

Provider Business Mailing Address
First Line	:	51 UPPER MONTCLAIR PLZ
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-1343
Country	:	US
Telephone Number	:	551-206-2888
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 UPPER MONTCLAIR PLZ STE 2
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-1340
Country	:	US
Telephone Number	:	551-206-2888
Fax Number	:

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

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	09/08/2020

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