MEDICARE: ABIGAIL FABER DCLINPSY

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	071.009591	IL

General Provider Information

NPI Number	:	1902477623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL FABER DCLINPSY

Provider Business Mailing Address
First Line	:	1410 W WRIGHTWOOD AVE APT I
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1140
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1552 S ROUTE 59 # 1027
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-5941
Country	:	US
Telephone Number	:	319-481-1203
Fax Number	:

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

Provider Enumeration Date	:	07/03/2021
Last Update Date	:	07/15/2021

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