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General NPI Number Information
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NPI Number | 1265592851
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Entity Type | Organization
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Legal Business Name | JUDITH JANARO FABIAN PHD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 182 GRANVILLE WAY
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City | SAN FRANCISCO
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State | CA
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Zip | 94127-1134
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Country | US
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Telephone | 415-771-7171
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Fax | 415-771-7171
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Provider Business Mailing Address
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Address Line | 182 GRANVILLE WAY
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City | SAN FRANCISCO
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State | CA
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Zip | 94127-1134
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Country | US
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Telephone | 415-771-7171
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Fax | 415-771-7171
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Authorized Official
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Title or Position | PRESIDENT & CHIEF EXECUTIVE OFFICER
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Name | DR. JUDITH JANARO FABIAN
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Credential | PHD ABPP
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Telephone | 415-771-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY3488
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License Number State | CA
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