Provider Demographics
NPI:1821389362
Name:FABISZAK, ELISA (LPC)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:FABISZAK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3820
Mailing Address - Country:US
Mailing Address - Phone:860-944-4412
Mailing Address - Fax:
Practice Address - Street 1:96 CONNECTICUT BLVD
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3013
Practice Address - Country:US
Practice Address - Phone:860-502-4908
Practice Address - Fax:860-513-4828
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001998101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional