Provider Demographics
NPI:1225347446
Name:JULIAN FABRY, PH.D., P.C.
Entity Type:Organization
Organization Name:JULIAN FABRY, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FABRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-551-7092
Mailing Address - Street 1:5014 DAVENPORT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2928
Mailing Address - Country:US
Mailing Address - Phone:402-551-7092
Mailing Address - Fax:402-551-7092
Practice Address - Street 1:5002 DODGE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2906
Practice Address - Country:US
Practice Address - Phone:402-551-7092
Practice Address - Fax:402-551-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE94103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE270273Medicare PIN