Provider Demographics
NPI:1316247232
Name:FAUCETTE, CAROLYN (LISW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:FAUCETTE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 5TH AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1765
Mailing Address - Country:US
Mailing Address - Phone:330-542-6573
Mailing Address - Fax:202-970-5606
Practice Address - Street 1:1350 5TH AVE STE 320
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1765
Practice Address - Country:US
Practice Address - Phone:330-542-6573
Practice Address - Fax:202-970-5606
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0900303S101YM0800X
OHI09003031041C0700X
OHI-0900303-SUPR1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0161000Medicaid
OH1629430764OtherGROUP NPI
OHH284091Medicare PIN
OH0161000Medicaid