Provider Demographics
NPI:1376765230
Name:FAERBER, RANDY CAROL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RANDY
Middle Name:CAROL
Last Name:FAERBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:BUCKINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SOCIAL WORKER/CLINIC
Mailing Address - Street 1:300 EAST 71ST STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-972-9884
Mailing Address - Fax:212-986-0997
Practice Address - Street 1:205 EAST 69TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5437
Practice Address - Country:US
Practice Address - Phone:917-848-4065
Practice Address - Fax:212-986-0997
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0328101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical