Provider Demographics
NPI:1134129422
Name:SIMMONS-FABER, KAREN (PHD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SIMMONS-FABER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 INDEPENDENCE BLVD
Mailing Address - Street 2:FAMILY MEDICAL PRACTITIONERS
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5545
Mailing Address - Country:US
Mailing Address - Phone:757-460-1207
Mailing Address - Fax:757-460-2136
Practice Address - Street 1:1147 INDEPENDENCE BLVD
Practice Address - Street 2:FAMILY MEDICAL PRACTITIONERS
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5545
Practice Address - Country:US
Practice Address - Phone:757-460-1207
Practice Address - Fax:757-460-2136
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002112103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0810002112OtherLIC
S16773Medicare UPIN