Healthcare Provider Details

I. General information

NPI: 1629157185
Provider Name (Legal Business Name): ROBERT J FABIANO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 PATIENT CARE WAY SUITE 104
LANSING MI
48911-4275
US

IV. Provider business mailing address

3960 PATIENT CARE WAY SUITE 104
LANSING MI
48911-4275
US

V. Phone/Fax

Practice location:
  • Phone: 517-887-9801
  • Fax: 517-887-9826
Mailing address:
  • Phone: 517-887-9801
  • Fax: 517-887-9826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301007285
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301007285
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: