Provider Demographics
NPI:1245418177
Name:SMITH, FABIAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:FABIAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 SW BURTON DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2521
Mailing Address - Country:US
Mailing Address - Phone:503-525-4949
Mailing Address - Fax:503-525-2568
Practice Address - Street 1:5445 SW BURTON DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2521
Practice Address - Country:US
Practice Address - Phone:503-525-4949
Practice Address - Fax:503-525-2568
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0022361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical