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Matthew Fava
Mental Health Clinic/Center (Including Community Mental Health Center) in Lodi, California
NPI 1821117284

Matthew Fava is a Mental Health Clinic/Center (Including Community Mental Health Center) based in Lodi, CA and is specialized in Mental Health (Including Community Mental Health Center). Matthew Fava practices in Lodi, CA. The NPI Number for Matthew Fava is 1821117284 and holds a License No. 47392 (California).

The current practice location address for Matthew Fava is 404 W Pine St, Lodi, CA and can be reached out via phone at 209-769-9554 and via fax at 209-435-0894.

Location: 404 W Pine St, Lodi, CA, 95240-0690
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1821117284
Provider Name
Matthew Fava
Credential
Provider Entity Type
Organization
Address
404 W Pine St, Lodi, CA, 95240-0690
Phone Number
209-769-9554
Fax Number
209-435-0894
Provider Enumeration Date
03/28/2007
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
404 W Pine St
City
Lodi
State
California
Zip
95240-2048
Phone Number
209-769-9554
Fax Number
209-435-0894
person
Provider Business Mailing Address Details
Address
404 W Pine St
City
Lodi
State
California
Zip
95240-2048
Phone Number
209-769-9554
Fax Number
209-435-0894
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Mental Health (Including Community Mental Health Center)
Taxonomy
261QM0801X
License No.
47392 (California)
Definition
Definition to come...
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