Doctor Name: | BRIANNA FAVA |
NPI Number: | 1851586408 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 019661 |
Business Practice Address: | 45 Route 25a Ste A2 Shoreham, NY - 117861389 |
Business Phone Number: | 6316553021 |
Business Fax Number: | |
Mailing Address: | 6 Sunset Ln E, MILLER PLACE |
State: | NY |
Postal Code: | 117641644 |
Phone Number: | 6316553021 |
Fax Number: | |
NPI Enumeration Date: | 09/06/2007 |
NPI Last Update Date: | 10/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 019661 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |