Provider Demographics
NPI:1740764158
Name:CONSBRUCK, FABIAN ALEXANDRO (PSYD)
Entity type:Individual
Prefix:DR
First Name:FABIAN
Middle Name:ALEXANDRO
Last Name:CONSBRUCK
Suffix:
Gender:
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:PO BOX 1128
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-1128
Mailing Address - Country:US
Mailing Address - Phone:720-340-8290
Mailing Address - Fax:
Practice Address - Street 1:3855 AMBROSIA ST STE 302
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3959
Practice Address - Country:US
Practice Address - Phone:720-340-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004889103TC0700X, 103TH0004X, 103G00000X
FL10642103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth