Provider Demographics
NPI:1255885125
Name:BAIN, FABIENNE (PHD)
Entity type:Individual
Prefix:DR
First Name:FABIENNE
Middle Name:
Last Name:BAIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2935
Mailing Address - Country:US
Mailing Address - Phone:716-866-3682
Mailing Address - Fax:
Practice Address - Street 1:240 ELM ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2935
Practice Address - Country:US
Practice Address - Phone:716-866-3682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11424103T00000X
NY021743103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist