Provider Demographics
NPI:1679795579
Name:FABIAN, PETER (DMN)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:FABIAN
Suffix:
Gender:M
Credentials:DMN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 TOKAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1436
Mailing Address - Country:US
Mailing Address - Phone:608-663-4861
Mailing Address - Fax:
Practice Address - Street 1:4413 TOKAY BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1436
Practice Address - Country:US
Practice Address - Phone:608-663-4861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI195-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist