Provider Demographics
NPI:1053592063
Name:JEFFREY E. FABACHER
Entity type:Organization
Organization Name:JEFFREY E. FABACHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:FABACHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-261-8188
Mailing Address - Street 1:700 2ND AVE N
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5756
Mailing Address - Country:US
Mailing Address - Phone:239-261-8188
Mailing Address - Fax:239-261-9144
Practice Address - Street 1:700 2ND AVE N
Practice Address - Street 2:SUITE 302
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5756
Practice Address - Country:US
Practice Address - Phone:239-261-8188
Practice Address - Fax:239-261-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055928101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1029Medicare PIN
FLE06805Medicare UPIN