Provider Demographics
NPI:1700610847
Name:FABER, LEAH (PSYD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:
Last Name:FABER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12791 WORLD PLAZA LN BLDG 89
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3989
Mailing Address - Country:US
Mailing Address - Phone:630-956-6332
Mailing Address - Fax:239-645-4777
Practice Address - Street 1:12791 WORLD PLAZA LN BLDG 89
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3989
Practice Address - Country:US
Practice Address - Phone:630-956-6332
Practice Address - Fax:239-645-4777
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical