Provider Demographics
NPI:1821115353
Name:FABRICIUS, SLOANE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SLOANE
Middle Name:
Last Name:FABRICIUS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 CALLE NORTE
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6812
Mailing Address - Country:US
Mailing Address - Phone:805-376-8132
Mailing Address - Fax:
Practice Address - Street 1:30497 CANWOOD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4330
Practice Address - Country:US
Practice Address - Phone:805-558-3871
Practice Address - Fax:818-706-9070
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40517106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist