Provider Demographics
NPI:1790330199
Name:UBFAL, FABIANA
Entity Type:Individual
Prefix:
First Name:FABIANA
Middle Name:
Last Name:UBFAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16375 NE 18TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4700
Mailing Address - Country:US
Mailing Address - Phone:786-246-4050
Mailing Address - Fax:
Practice Address - Street 1:16375 NE 18TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4700
Practice Address - Country:US
Practice Address - Phone:786-246-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17229101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health