Provider Demographics
NPI:1558561084
Name:FABBRO, SUSAN G (MFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:FABBRO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 WOODSIDE RD STE 211
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3402
Mailing Address - Country:US
Mailing Address - Phone:650-368-5325
Mailing Address - Fax:650-368-0212
Practice Address - Street 1:1690 WOODSIDE RD STE 211
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3402
Practice Address - Country:US
Practice Address - Phone:650-368-5325
Practice Address - Fax:650-368-0212
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37250106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist