Provider Demographics
NPI:1013094333
Name:FAULKNER, SANDRA S (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:S
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-4820
Mailing Address - Country:US
Mailing Address - Phone:412-366-5820
Mailing Address - Fax:412-366-7048
Practice Address - Street 1:610 OLIVE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-4820
Practice Address - Country:US
Practice Address - Phone:412-366-5820
Practice Address - Fax:412-366-7048
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000745L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA905720Medicare UPIN