Provider Demographics
NPI:1689270399
Name:FABER-BROOK, SUSAN E (CA LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:FABER-BROOK
Suffix:
Gender:F
Credentials:CA LCSW
Other - Prefix:MS
Other - First Name:SUAN
Other - Middle Name:E
Other - Last Name:FABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:532 ISLAND VIEW CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041
Mailing Address - Country:US
Mailing Address - Phone:310-399-6655
Mailing Address - Fax:
Practice Address - Street 1:532 ISLAND VIEW CIRCLE
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041
Practice Address - Country:US
Practice Address - Phone:310-399-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS78191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical