Provider Demographics
NPI:1336160365
Name:FAUBEL, MARIALICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIALICE
Middle Name:
Last Name:FAUBEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11060 EL AMARILLO AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4904
Mailing Address - Country:US
Mailing Address - Phone:714-434-3656
Mailing Address - Fax:714-913-6022
Practice Address - Street 1:11060 EL AMARILLO AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4904
Practice Address - Country:US
Practice Address - Phone:714-434-3656
Practice Address - Fax:714-913-6022
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14320103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist