Provider Demographics
NPI:1710054879
Name:FABBRI, KIMBERLY ANN (MFT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:FABBRI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:FABBRI-DEVOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:77011 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:SAN MIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:93451-9099
Mailing Address - Country:US
Mailing Address - Phone:831-682-4946
Mailing Address - Fax:
Practice Address - Street 1:77011 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:SAN MIGUEL
Practice Address - State:CA
Practice Address - Zip Code:93451-9099
Practice Address - Country:US
Practice Address - Phone:831-682-4946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40192106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist