Provider Demographics
NPI:1780894782
Name:FABBRE, VANESSA D (LCSW)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:D
Last Name:FABBRE
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 1:2740 N PINE GROVE AVE
Mailing Address - Street 2:UNIT 3A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6137
Mailing Address - Country:US
Mailing Address - Phone:773-428-3873
Mailing Address - Fax:
Practice Address - Street 1:2740 N PINE GROVE AVE
Practice Address - Street 2:UNIT 3A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6137
Practice Address - Country:US
Practice Address - Phone:773-428-3873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1500110181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical