Provider Demographics
NPI:1720571953
Name:FINNETTE W. FABRICK, PH.D.
Entity Type:Organization
Organization Name:FINNETTE W. FABRICK, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT, SCOOL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FINNETTE
Authorized Official - Middle Name:W
Authorized Official - Last Name:FABRICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-262-1060
Mailing Address - Street 1:4111 NW 16TH DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1972
Mailing Address - Country:US
Mailing Address - Phone:352-262-1060
Mailing Address - Fax:
Practice Address - Street 1:4111 NW 16TH DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1972
Practice Address - Country:US
Practice Address - Phone:352-262-1060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMFT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health