Healthcare Provider Details

I. General information

NPI: 1831122936
Provider Name (Legal Business Name): JULIAN JOSEPH FABRY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 DODGE ST STE 205
OMAHA NE
68132-2906
US

IV. Provider business mailing address

5014 DAVENPORT ST
OMAHA NE
68132-2928
US

V. Phone/Fax

Practice location:
  • Phone: 402-551-7092
  • Fax: 402-551-7092
Mailing address:
  • Phone: 402-551-7092
  • Fax: 402-551-7092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number94
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: