Provider Demographics
NPI:1669877080
Name:KACIAN FABISH LPC
Entity type:Organization
Organization Name:KACIAN FABISH LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPEITIER
Authorized Official - Prefix:MS
Authorized Official - First Name:KACIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FABISH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-308-9651
Mailing Address - Street 1:60 CONNOLLY PKWY
Mailing Address - Street 2:BLDG 2A SUITE 212
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2593
Mailing Address - Country:US
Mailing Address - Phone:203-308-9651
Mailing Address - Fax:
Practice Address - Street 1:60 CONNOLLY PKWY
Practice Address - Street 2:BLDG 2A SUITE 212
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2593
Practice Address - Country:US
Practice Address - Phone:203-308-9651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 106H00000X
CT001783101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty