Provider Demographics
NPI:1902645245
Name:TAVERNIER, FABIENNE
Entity type:Individual
Prefix:
First Name:FABIENNE
Middle Name:
Last Name:TAVERNIER
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 1:44 THREE MILE HARBOR HC
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-1253
Mailing Address - Country:US
Mailing Address - Phone:631-487-8589
Mailing Address - Fax:
Practice Address - Street 1:44 THREE MILE HARBOR HC
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-1253
Practice Address - Country:US
Practice Address - Phone:631-487-8589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health