Provider Demographics
NPI:1003147232
Name:DALE W. FABER, LCSW, P.C.
Entity Type:Organization
Organization Name:DALE W. FABER, LCSW, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:W
Authorized Official - Last Name:FABER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD MDIV
Authorized Official - Phone:630-926-4873
Mailing Address - Street 1:1035 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4636
Mailing Address - Country:US
Mailing Address - Phone:630-926-4873
Mailing Address - Fax:630-852-6335
Practice Address - Street 1:1035 GROVE ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4636
Practice Address - Country:US
Practice Address - Phone:630-926-4873
Practice Address - Fax:630-852-6335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-008480261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2223316OtherBLUE CROSS BLUE SHIELD
IL708550Medicare PIN