Provider Demographics
NPI:1821348640
Name:JAMIESON, FABIOLA MARQUEZ (LCSW)
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:MARQUEZ
Last Name:JAMIESON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 2ND AVE
Mailing Address - Street 2:APT B
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103
Mailing Address - Country:US
Mailing Address - Phone:801-360-5191
Mailing Address - Fax:
Practice Address - Street 1:4500 S 2180 E
Practice Address - Street 2:SUITE 165
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117
Practice Address - Country:US
Practice Address - Phone:801-461-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT737639635011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical