Provider Demographics
NPI:1740331610
Name:FABRIZIO, CARL JR (PSYD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:FABRIZIO
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 BLOOMFIELD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650
Mailing Address - Country:US
Mailing Address - Phone:949-275-2027
Mailing Address - Fax:909-606-5075
Practice Address - Street 1:11401 BLOOMFIELD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:909-606-5000
Practice Address - Fax:909-606-5075
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14542103TC0700X, 103TC2200X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic