Provider Demographics
NPI:1265726293
Name:FAUST, STEPHANIE L (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:FAUST
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 1:72 SUBSTATION RD
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:PA
Mailing Address - Zip Code:16661-8912
Mailing Address - Country:US
Mailing Address - Phone:814-577-0161
Mailing Address - Fax:
Practice Address - Street 1:72 SUBSTATION RD
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:PA
Practice Address - Zip Code:16661-8912
Practice Address - Country:US
Practice Address - Phone:814-577-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW018033101Y00000X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
353498Medicare PIN