Provider Demographics
NPI:1811708431
Name:JEFFREY P FAUDE, PH.D.
Entity type:Organization
Organization Name:JEFFREY P FAUDE, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:FAUDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-613-1072
Mailing Address - Street 1:604 S WASHINGTON SQ APT 1616
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4125
Mailing Address - Country:US
Mailing Address - Phone:610-613-1072
Mailing Address - Fax:
Practice Address - Street 1:604 S WASHINGTON SQ APT 1616
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4125
Practice Address - Country:US
Practice Address - Phone:610-613-1072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFREY P FAUDE, PH.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty