Provider Demographics
NPI:1013340488
Name:CASANOVA, FABIANA (MA)
Entity Type:Individual
Prefix:
First Name:FABIANA
Middle Name:
Last Name:CASANOVA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 BEACON ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-1236
Mailing Address - Country:US
Mailing Address - Phone:617-936-0309
Mailing Address - Fax:617-936-0609
Practice Address - Street 1:264 BEACON ST FL 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-1236
Practice Address - Country:US
Practice Address - Phone:617-936-0309
Practice Address - Fax:617-936-0609
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health