Provider Demographics
NPI:1518780915
Name:FABOZZI, YANIRA CANDELARIA
Entity type:Individual
Prefix:MRS
First Name:YANIRA
Middle Name:CANDELARIA
Last Name:FABOZZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6916 TOMY LEE TRL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-1658
Mailing Address - Country:US
Mailing Address - Phone:229-232-0740
Mailing Address - Fax:
Practice Address - Street 1:820 E PARK AVE STE I100
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2600
Practice Address - Country:US
Practice Address - Phone:850-765-6769
Practice Address - Fax:850-270-6932
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW210101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical