Provider Demographics
NPI:1710425517
Name:FABIAN, LISANDRO (MD)
Entity type:Individual
Prefix:
First Name:LISANDRO
Middle Name:
Last Name:FABIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LISANDRO
Other - Middle Name:
Other - Last Name:FABIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:205 COMMANDER CV
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554
Mailing Address - Country:US
Mailing Address - Phone:571-516-0132
Mailing Address - Fax:
Practice Address - Street 1:205 COMMANDER CV
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-2401
Practice Address - Country:US
Practice Address - Phone:571-516-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003838101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health