Provider Demographics
NPI:1295193381
Name:FABER, JOHN F (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:FABER
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6965 AVENUE DES PALAIS
Mailing Address - Street 2:1B
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2834
Mailing Address - Country:US
Mailing Address - Phone:727-744-9666
Mailing Address - Fax:727-313-9606
Practice Address - Street 1:146 2ND ST N
Practice Address - Street 2:SUITE 310
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3328
Practice Address - Country:US
Practice Address - Phone:727-744-9666
Practice Address - Fax:727-313-9606
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW130851041C0700X
PASW01087821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical