Basic Information
| Provider Information | |||||||||
| NPI: | 1194043562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAUST | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | AARON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CONSTITUTION PLZ | ||||||||
| Address2: | |||||||||
| City: | CHARLESTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021292025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177245202 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9757 BLUE RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | BLUE RIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305134167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107515344 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2010 | ||||||||
| LastUpdateDate: | 07/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 11303 | MA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.