Provider Demographics
NPI:1164266847
Name:FAUST, BLAIR ALEXANDER (BS, MSW)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:ALEXANDER
Last Name:FAUST
Suffix:
Gender:M
Credentials:BS, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 WASHINGTON ST APT B104
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8054
Mailing Address - Country:US
Mailing Address - Phone:786-461-0398
Mailing Address - Fax:
Practice Address - Street 1:5540 WASHINGTON ST APT B104
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8054
Practice Address - Country:US
Practice Address - Phone:786-461-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL205251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical