Basic Information
| Provider Information | |||||||||
| NPI: | 1790187755 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAUST | ||||||||
| FirstName: | JUDITH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 CLERMONT CENTER DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BATAVIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451031990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137358300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 CLERMONT CENTER DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BATAVIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451031990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137358300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2014 | ||||||||
| LastUpdateDate: | 09/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TS0200X | CI1011502 | OH | Y | Behavioral Health & Social Service Providers | Psychologist | School |
No ID Information.