Provider Demographics
NPI:1831122936
Name:FABRY, JULIAN JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:JOSEPH
Last Name:FABRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 DAVENPORT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2928
Mailing Address - Country:US
Mailing Address - Phone:402-551-7092
Mailing Address - Fax:402-551-7092
Practice Address - Street 1:5002 DODGE ST STE 205
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2906
Practice Address - Country:US
Practice Address - Phone:402-551-7092
Practice Address - Fax:402-551-7092
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE94103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080972300Medicaid
NE47080972300Medicaid