Provider Demographics
NPI:1285020081
Name:FABIENNE BISARO
Entity Type:Organization
Organization Name:FABIENNE BISARO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FABIENNE
Authorized Official - Middle Name:CHLOEE
Authorized Official - Last Name:BISARO
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:808-936-9298
Mailing Address - Street 1:PO BOX 1163
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-1163
Mailing Address - Country:US
Mailing Address - Phone:808-936-9298
Mailing Address - Fax:
Practice Address - Street 1:45-3381 KUKUI ST
Practice Address - Street 2:
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727
Practice Address - Country:US
Practice Address - Phone:808-936-9298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI427251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health