Basic Information
| Provider Information | |||||||||
| NPI: | 1710054879 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FABBRI | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19122 MARJORIE RD | ||||||||
| Address2: | |||||||||
| City: | PRUNEDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939078459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316632984 | ||||||||
| FaxNumber: | 8316632984 | ||||||||
| Practice Location | |||||||||
| Address1: | 17615 MORO RD | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939078541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316633927 | ||||||||
| FaxNumber: | 8316630605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 106H00000X | 40192 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.