Provider Demographics
NPI:1689937401
Name:POWELL, FABIOLA (MED)
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GRANT ST
Mailing Address - Street 2:UNIT 15
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4764
Mailing Address - Country:US
Mailing Address - Phone:774-259-4039
Mailing Address - Fax:
Practice Address - Street 1:300 HOWARD STREET
Practice Address - Street 2:SOUTH MIDDLESEX OPPORTUNITY COUNCIL
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702
Practice Address - Country:US
Practice Address - Phone:508-879-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP1600X
MA354579101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional