Healthcare Provider Details

I. General information

NPI: 1780134742
Provider Name (Legal Business Name): ELIZABETH FABRICANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH FOBARE

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 HIGHLAND AVE
NEEDHAM MA
02494-3036
US

IV. Provider business mailing address

237 HIGHLAND AVE
NEEDHAM MA
02494-3036
US

V. Phone/Fax

Practice location:
  • Phone: 781-752-8823
  • Fax: 781-559-3192
Mailing address:
  • Phone: 781-752-8823
  • Fax: 781-559-3192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: