Provider Demographics
NPI:1104591247
Name:DOVER-FAISON, MALAYSIA (LMSW)
Entity type:Individual
Prefix:
First Name:MALAYSIA
Middle Name:
Last Name:DOVER-FAISON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 OCEAN AVE APT D7
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5387
Mailing Address - Country:US
Mailing Address - Phone:347-881-5210
Mailing Address - Fax:
Practice Address - Street 1:672 OCEAN AVE APT D7
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5387
Practice Address - Country:US
Practice Address - Phone:347-881-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112744-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker