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General NPI Number Information
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NPI Number | 1740764158
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Entity Type | Individual
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Provider Name | FABIAN ALEXANDRO CONSBRUCK PSYD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 3855 AMBROSIA ST STE 302
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City | CASTLE ROCK
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State | CO
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Zip | 80109-3959
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Country | US
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Telephone | 720-340-8290
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1128
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City | GUAYNABO
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State | PR
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Zip | 00970-1128
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Country | US
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Telephone | 720-340-8290
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY.0004889
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 10642
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number | PSY.0004889
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY.0004889
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License Number State | CO
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