Provider Demographics
NPI:1982759239
Name:FABRY, LUCINDA ANN (PSY 20776)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:ANN
Last Name:FABRY
Suffix:
Gender:F
Credentials:PSY 20776
Other - Prefix:
Other - First Name:LUCINDA
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3054 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003
Mailing Address - Country:US
Mailing Address - Phone:831-423-9444
Mailing Address - Fax:831-423-1532
Practice Address - Street 1:104 WALNUT AVE
Practice Address - Street 2:STE 208
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3929
Practice Address - Country:US
Practice Address - Phone:831-423-1532
Practice Address - Fax:831-423-1532
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20776103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY20776OtherPSYCHOLOGIST LICENCE NUMB