Individual
BRIANNA FAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
45 ROUTE 25A STE A2, SHOREHAM, NY 11786-1389
(631) 655-3021
Mailing address
6 SUNSET LN E, MILLER PLACE, NY 11764-1644
(631) 655-3021
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
019661
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00355940
—
NY
01
—
1285628552
NPI NUMBER
NY
Enumeration date
09/06/2007
Last updated
10/12/2012
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