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NPI Code Detail

MEDICARE: MRS. NICOLETTE R FABICK PLPC

MEDICARE: MRS. NICOLETTE R FABICK PLPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor2025013018MO

General Provider Information

NPI Number : 1285528810
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLETTE R FABICK PLPC
Provider Business Mailing Address
First Line : 108 PARK AVE
Second Line :
City : KIRKWOOD
State : MO
Zip : 63122-4514
Country : US
Telephone Number : 314-578-3817
Fax Number :
Provider Business Practice Location Address
First Line : 50 CRESTWOOD EXECUTIVE CTR STE 500
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63126-1948
Country : US
Telephone Number : 314-329-5374
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2025
Last Update Date : 06/06/2025

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