Provider Demographics
NPI:1467570838
Name:FABIAN, SANDRA S (MALMHC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:S
Last Name:FABIAN
Suffix:
Gender:F
Credentials:MALMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BARTEAU LN
Mailing Address - Street 2:
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719
Mailing Address - Country:US
Mailing Address - Phone:617-491-5016
Mailing Address - Fax:
Practice Address - Street 1:14 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:617-491-5016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0351OtherBL CROSS BL SHIELD