MEDICARE: ROBERT J FAYLE 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	009396	CT

General Provider Information

NPI Number	:	1730408980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J FAYLE LCSW

Provider Business Mailing Address
First Line	:	354 BIRCH MOUNTAIN RD
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033
Country	:	US
Telephone Number	:	860-970-7624
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 NEW BRITAIN AVE STE 201
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06110-2447
Country	:	US
Telephone Number	:	860-970-7624
Fax Number	:

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

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	09/20/2017

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