Basic Information
| Provider Information | |||||||||
| NPI: | 1689937401 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | FABIOLA | ||||||||
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| Credential: | M.ED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 GRANT ST | ||||||||
| Address2: | UNIT 15 | ||||||||
| City: | NATICK | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017604764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7742594039 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 HOWARD STREET | ||||||||
| Address2: | SOUTH MIDDLESEX OPPORTUNITY COUNCIL | ||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088792250 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 06/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP1600X | N | Behavioral Health & Social Service Providers | Counselor | Pastoral | 101YP2500X | 354579 | MA | N | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.