Provider Demographics
NPI:1972203958
Name:FABRE, FAUSTO GABRIEL SR
Entity type:Individual
Prefix:
First Name:FAUSTO
Middle Name:GABRIEL
Last Name:FABRE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3068 BEL PRE RD APT 301
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2487
Mailing Address - Country:US
Mailing Address - Phone:240-660-1311
Mailing Address - Fax:
Practice Address - Street 1:3068 BEL PRE RD APT 301
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2487
Practice Address - Country:US
Practice Address - Phone:240-660-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician