Provider Demographics
NPI:1548352776
Name:WILBUR, FAYE SUE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:FAYE
Middle Name:SUE
Last Name:WILBUR
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4824
Mailing Address - Country:US
Mailing Address - Phone:718-258-1046
Mailing Address - Fax:
Practice Address - Street 1:1273 53RD ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3820
Practice Address - Country:US
Practice Address - Phone:718-435-5700
Practice Address - Fax:718-854-5495
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027416-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker