Provider Demographics
NPI:1932200763
Name:FABIANO, JESSICA S (LICSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:FABIANO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SNOWBERRY CT
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-4000
Mailing Address - Country:US
Mailing Address - Phone:401-286-1917
Mailing Address - Fax:
Practice Address - Street 1:640 GEORGE WASHINGTON HIGHWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865
Practice Address - Country:US
Practice Address - Phone:401-286-1917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW018471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJC52646Medicaid