Provider Demographics
NPI:1982898334
Name:FABIAN, DOUGLAS BLAINE (LICENSED SOCIAL WORK)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:BLAINE
Last Name:FABIAN
Suffix:
Gender:M
Credentials:LICENSED SOCIAL WORK
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2969 MAIN ST
Mailing Address - Street 2:SUICIDE PREVENTION AND CRISIS SERVICE INC
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214
Mailing Address - Country:US
Mailing Address - Phone:716-834-2310
Mailing Address - Fax:716-834-9881
Practice Address - Street 1:2969 MAIN ST
Practice Address - Street 2:SUICIDE PREVENTION AND CRISIS SERVICE INC
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214
Practice Address - Country:US
Practice Address - Phone:716-834-2310
Practice Address - Fax:716-834-9881
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0192041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0192041OtherNY STATE LICENSE SOCIAL W