Provider Demographics
NPI:1700177714
Name:FABIAN, TONI ANN (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:TONI
Middle Name:ANN
Last Name:FABIAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 N BICYCLE PATH
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2249
Mailing Address - Country:US
Mailing Address - Phone:631-275-5356
Mailing Address - Fax:
Practice Address - Street 1:124 ROUTE 112
Practice Address - Street 2:SUITE C
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1232
Practice Address - Country:US
Practice Address - Phone:631-714-5123
Practice Address - Fax:631-714-5124
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072029-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical