Provider Demographics
NPI:1912116310
Name:FALLER, GEORGE R (LMFT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:R
Last Name:FALLER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DAISY DR
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-5526
Mailing Address - Country:US
Mailing Address - Phone:914-556-8540
Mailing Address - Fax:
Practice Address - Street 1:110 LOCKWOOD AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5028
Practice Address - Country:US
Practice Address - Phone:914-434-0520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000202106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist