Healthcare Provider Details

I. General information

NPI: 1568399376
Provider Name (Legal Business Name): LUKE FABISIAK MS, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 EXECUTIVE DR STE 102
CRANBERRY TOWNSHIP PA
16066-6408
US

IV. Provider business mailing address

215 EXECUTIVE DR STE 102
CRANBERRY TOWNSHIP PA
16066-6408
US

V. Phone/Fax

Practice location:
  • Phone: 724-776-5690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC019634
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: