Provider Demographics
NPI:1720675846
Name:DESIRE, FABIOLA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:FABIOLA
Middle Name:
Last Name:DESIRE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 PINEWALK DR N APT 1336
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-9351
Mailing Address - Country:US
Mailing Address - Phone:954-736-6442
Mailing Address - Fax:
Practice Address - Street 1:3360 PINEWALK DR N APT 1336
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-9351
Practice Address - Country:US
Practice Address - Phone:954-736-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW176211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty