Provider Demographics
NPI:1881718948
Name:FABER, DALE W (PHD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:W
Last Name:FABER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4636
Mailing Address - Country:US
Mailing Address - Phone:630-926-4873
Mailing Address - Fax:630-852-0740
Practice Address - Street 1:1035 GROVE ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4636
Practice Address - Country:US
Practice Address - Phone:630-926-4873
Practice Address - Fax:630-852-6335
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009890103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2223316OtherBLUE CROSS BLUE SHIELD
IL2223316OtherBLUE CROSS BLUE SHIELD