Provider Demographics
NPI:1265062632
Name:FAUCHER, NINA LAURIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:LAURIE
Last Name:FAUCHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:816 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-5207
Mailing Address - Country:US
Mailing Address - Phone:518-364-6632
Mailing Address - Fax:518-565-0533
Practice Address - Street 1:6 CHELSEA PL STE 103
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3236
Practice Address - Country:US
Practice Address - Phone:844-253-4229
Practice Address - Fax:518-565-0533
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0465531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical