Basic Information
| Provider Information | |||||||||
| NPI: | 1104012608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FABIAN | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 90TH ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940151879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503018650 | ||||||||
| FaxNumber: | 6503417389 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 90TH ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940151879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5623975665 | ||||||||
| FaxNumber: | 6503417389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2007 | ||||||||
| LastUpdateDate: | 08/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 27352 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.