Provider Demographics
NPI:1376162560
Name:JABOUIN-MONNAY, FANYA (LMFT)
Entity type:Individual
Prefix:DR
First Name:FANYA
Middle Name:
Last Name:JABOUIN-MONNAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:DR
Other - First Name:FANYA
Other - Middle Name:
Other - Last Name:JABOUIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:11410 NW 30TH PL
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-1628
Mailing Address - Country:US
Mailing Address - Phone:954-614-7371
Mailing Address - Fax:
Practice Address - Street 1:1580 SAWGRASS CORPORATE PKWY STE 130
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2860
Practice Address - Country:US
Practice Address - Phone:954-315-4558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2501106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist