Provider Demographics
NPI:1841322336
Name:FABRIS, ANASTATIA (LCSW)
Entity type:Individual
Prefix:MISS
First Name:ANASTATIA
Middle Name:
Last Name:FABRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANASTATIA
Other - Middle Name:
Other - Last Name:POLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2005 PALMER AVE # 1182
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2437
Mailing Address - Country:US
Mailing Address - Phone:929-445-3346
Mailing Address - Fax:
Practice Address - Street 1:51 E 42ND ST
Practice Address - Street 2:SUITE 1400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5404
Practice Address - Country:US
Practice Address - Phone:212-505-4282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069704-011041C0700X
NY0697041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNH4251Medicare ID - Type UnspecifiedMEDICARE PROVIDER