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General NPI Number Information
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NPI Number | 1033411467
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Entity Type | Individual
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Provider Name | LYDELL CHRISTOPHER FABIN MSW
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Gender | Male
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 98-459 HOOKANIKE ST APT 65
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City | PEARL CITY
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State | HI
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Zip | 96782-2350
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Country | US
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Telephone | 808-358-1981
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Fax |
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Provider Business Mailing Address
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Address Line | 98-459 HOOKANIKE ST. APT 65
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City | PEARL CITY
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State | HI
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Zip | 96782-0001
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Country | US
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Telephone | 808-358-1981
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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