Healthcare Provider Details

I. General information

NPI: 1669877080
Provider Name (Legal Business Name): KACIAN FABISH LPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CONNOLLY PKWY BLDG 2A SUITE 212
HAMDEN CT
06514-2593
US

IV. Provider business mailing address

60 CONNOLLY PKWY BLDG 2A SUITE 212
HAMDEN CT
06514-2593
US

V. Phone/Fax

Practice location:
  • Phone: 203-308-9651
  • Fax:
Mailing address:
  • Phone: 203-308-9651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001783
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. KACIAN FABISH
Title or Position: SOLE PROPEITIER
Credential: LPC
Phone: 203-308-9651