Provider Demographics
NPI:1619348000
Name:FABIAN, JANET ROSE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:ROSE
Last Name:FABIAN
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 1:41 ASTER DR
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2136
Mailing Address - Country:US
Mailing Address - Phone:516-840-1245
Mailing Address - Fax:
Practice Address - Street 1:1044 FRANKLIN AVE
Practice Address - Street 2:STE 209
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2938
Practice Address - Country:US
Practice Address - Phone:516-387-5223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0847881041C0700X
NY087509104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker