Provider Demographics
NPI:1134100258
Name:FAUBLE, MANDY ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:ANN
Last Name:FAUBLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:ANN
Other - Last Name:SCHAUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1330 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1402
Mailing Address - Country:US
Mailing Address - Phone:814-459-9300
Mailing Address - Fax:814-454-7780
Practice Address - Street 1:1330 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1402
Practice Address - Country:US
Practice Address - Phone:814-459-9300
Practice Address - Fax:814-454-7780
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0149061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001679712OtherHIGHMARK
PA467400OtherVALUEOPTIONS
PA530903-000OtherMAGELLANE
PA7717663OtherAETNA