Provider Demographics
NPI:1306095120
Name:FABER, ANTHONY JEROME (PHD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JEROME
Last Name:FABER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 MERRIWETHER ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6209
Mailing Address - Country:US
Mailing Address - Phone:573-986-6814
Mailing Address - Fax:573-651-2949
Practice Address - Street 1:1427 THOMAS DR
Practice Address - Street 2:SUITE 106
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2129
Practice Address - Country:US
Practice Address - Phone:573-986-6814
Practice Address - Fax:573-651-2949
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008002561106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist