Provider Demographics
NPI:1881830065
Name:FAUGNO, MARTIN F (MSW)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:F
Last Name:FAUGNO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7003 N FIGUEROA ST OYHFS
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-1247
Mailing Address - Country:US
Mailing Address - Phone:323-543-2943
Mailing Address - Fax:323-344-7382
Practice Address - Street 1:7003 N FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-1247
Practice Address - Country:US
Practice Address - Phone:323-543-2943
Practice Address - Fax:323-344-7382
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25423101YM0800X
CAASW65093101YM0800X
CA793171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA79317OtherSOCIAL WORK