Provider Demographics
NPI:1619090701
Name:FABIAN, TODD (MA, BCBA)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:
Last Name:FABIAN
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19415 BENEDICT DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-9027
Mailing Address - Country:US
Mailing Address - Phone:209-993-5688
Mailing Address - Fax:
Practice Address - Street 1:405 E PINE ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5522
Practice Address - Country:US
Practice Address - Phone:209-464-5519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor