Provider Demographics
NPI:1023384112
Name:FABER, STEPHANIE JO (LICSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:FABER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 HARMON PLACE
Mailing Address - Street 2:STE 103
Mailing Address - City:MPLS
Mailing Address - State:MN
Mailing Address - Zip Code:55403
Mailing Address - Country:US
Mailing Address - Phone:612-313-3240
Mailing Address - Fax:612-338-5902
Practice Address - Street 1:1606 WASHINGTON ST NE # 2
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1336
Practice Address - Country:US
Practice Address - Phone:763-221-9084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN165731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical