Provider Demographics
NPI:1356352793
Name:FAERI, JAN (PSYD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:FAERI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6457 REFLECTIONS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2352
Mailing Address - Country:US
Mailing Address - Phone:614-792-1108
Mailing Address - Fax:614-792-0018
Practice Address - Street 1:6457 REFLECTIONS DR STE 120
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2352
Practice Address - Country:US
Practice Address - Phone:614-792-1108
Practice Address - Fax:614-792-0018
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4350103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP15127Medicaid
OH0968538Medicaid
OHR54283Medicare UPIN