Provider Demographics
NPI:1013107481
Name:FABII, DIANE (MS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:FABII
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 ROGERS WALK
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3454
Mailing Address - Country:US
Mailing Address - Phone:856-313-5585
Mailing Address - Fax:
Practice Address - Street 1:2404 ROGERS WALK
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3454
Practice Address - Country:US
Practice Address - Phone:856-313-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00181400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist