Provider Demographics
NPI:1467907071
Name:LIZAIRE, FABIOLA
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:
Last Name:LIZAIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 TAUNTON ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019-1426
Mailing Address - Country:US
Mailing Address - Phone:860-639-4931
Mailing Address - Fax:
Practice Address - Street 1:24 TAUNTON ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019-1426
Practice Address - Country:US
Practice Address - Phone:860-639-4931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA10644101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health