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General NPI Number Information
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NPI Number | 1467838672
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Entity Type | Individual
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Provider Name | FABIENNE BISARO M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 651026 MAMALAHOA HWY
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City | KAMUELA
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State | HI
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Zip | 96743
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Country | US
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Telephone | 808-936-9298
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1163
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City | HONOKAA
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State | HI
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Zip | 96727-1163
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Country | US
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Telephone | 808-936-9298
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT-427
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License Number State | HI
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