Provider Demographics
NPI:1508966029
Name:FAYNBERG, TATYANA F (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:TATYANA
Middle Name:F
Last Name:FAYNBERG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 TURNPIKE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2353
Mailing Address - Country:US
Mailing Address - Phone:781-821-1516
Mailing Address - Fax:781-821-1743
Practice Address - Street 1:275 TURNPIKE ST STE 105
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2353
Practice Address - Country:US
Practice Address - Phone:781-821-1516
Practice Address - Fax:781-821-1743
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5235101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor