Provider Demographics
NPI:1407688401
Name:FABARO, GRYSELL
Entity type:Individual
Prefix:
First Name:GRYSELL
Middle Name:
Last Name:FABARO
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 1:2820 S ALMA SCHOOL RD # 18-626
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-4392
Mailing Address - Country:US
Mailing Address - Phone:602-245-1364
Mailing Address - Fax:
Practice Address - Street 1:400 N CORONADO ST APT 1055
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4187
Practice Address - Country:US
Practice Address - Phone:602-245-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-22353104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker