1689270399 NPI number — MS. SUSAN E. FABER-BROOK CA LCSW

Table of content: MS. SUSAN E. FABER-BROOK CA LCSW (NPI 1689270399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689270399 NPI number — MS. SUSAN E. FABER-BROOK CA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FABER-BROOK
Provider First Name:
SUSAN
Provider Middle Name:
E.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CA LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FABER
Provider Other First Name:
SUAN
Provider Other Middle Name:
E.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689270399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
532 ISLAND VIEW CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT HUENEME
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-399-6655
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
532 ISLAND VIEW CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT HUENEME
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-399-6655
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS7819 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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