Provider Demographics
NPI:1073510384
Name:LEE M. FAVER PHD PSYCHOLOGIST PC
Entity Type:Organization
Organization Name:LEE M. FAVER PHD PSYCHOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT; LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:MITCH
Authorized Official - Last Name:FAVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD ABPP
Authorized Official - Phone:716-553-3319
Mailing Address - Street 1:12 RADCLIFFE RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1221
Mailing Address - Country:US
Mailing Address - Phone:716-553-3319
Mailing Address - Fax:
Practice Address - Street 1:12 RADCLIFFE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1221
Practice Address - Country:US
Practice Address - Phone:716-553-3319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011953103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0220Medicare ID - Type UnspecifiedGROUP/CORPORATION