MEDICARE: MR. MATTHEW FAAULI 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
1	1041C0700X	Clinical Social Worker	0904006398	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518101385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW FAAULI LCSW

Provider Business Mailing Address
First Line	:	3143 MAGIC HOLLOW BLVD
Second Line	:	STE 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-3077
Country	:	US
Telephone Number	:	757-385-8222
Fax Number	:	757-368-6796

Provider Business Practice Location Address
First Line	:	3134 MAGIC HOLLOW BLVD
Second Line	:	STE 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453
Country	:	US
Telephone Number	:	757-385-8222
Fax Number	:	757-368-6796

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

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	12/06/2012

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