Provider Demographics
NPI:1295993053
Name:FAU, GARY A (MA LPC)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:A
Last Name:FAU
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 SPRUCE STREET SUITE 205
Mailing Address - Street 2:GREATER TRENTON BEHAVIORAL HEALTHCARE
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-3957
Mailing Address - Country:US
Mailing Address - Phone:609-396-6788
Mailing Address - Fax:609-989-1245
Practice Address - Street 1:832 BRUNSWICK AVENUE
Practice Address - Street 2:BERMINGHAM CLINIC
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-3829
Practice Address - Country:US
Practice Address - Phone:609-396-8877
Practice Address - Fax:609-396-6024
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00060900101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional