Healthcare Provider Details

I. General information

NPI: 1699820035
Provider Name (Legal Business Name): LYDIA J. FABBRONI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GRACELAND DR SE SUITE E
ALBUQUERQUE NM
87108-2778
US

IV. Provider business mailing address

3412 MOUNTAINSIDE PKWY NE
ALBUQUERQUE NM
87111-5192
US

V. Phone/Fax

Practice location:
  • Phone: 505-249-0466
  • Fax:
Mailing address:
  • Phone: 505-249-0466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-05561
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: