Provider Demographics
NPI:1376732933
Name:LABERNIK-FABELA, JULIE N (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:N
Last Name:LABERNIK-FABELA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 S MOONSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6153
Mailing Address - Country:US
Mailing Address - Phone:208-477-7592
Mailing Address - Fax:
Practice Address - Street 1:5440 W FRANKLIN RD STE 108
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-6433
Practice Address - Country:US
Practice Address - Phone:208-283-7314
Practice Address - Fax:208-228-5794
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-302621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical