| Lewis A. Fabrick, Phd, Pa | |
|
2833 Nw 41st St Ste 140 Gainesville FL 32606-6987 | |
| (352) 338-0397 | |
| (352) 372-6787 |
| Full Name | Lewis A. Fabrick, Phd, Pa |
|---|---|
| Speciality | Social Worker |
| Location | 2833 Nw 41st St Ste 140, Gainesville, Florida |
| Authorized Official Name and Position | Lewis A. Fabrick (OWNER) |
| Authorized Official Contact | 3523380397 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lewis A. Fabrick, Phd, Pa 2833 Nw 41st St Ste 140 Gainesville FL 32606-6987 Ph: (352) 338-0397 | Lewis A. Fabrick, Phd, Pa 2833 Nw 41st St Ste 140 Gainesville FL 32606-6987 Ph: (352) 338-0397 |
| NPI Number | 1508252867 |
|---|---|
| Provider Enumeration Date | 04/13/2015 |
| Last Update Date | 06/03/2015 |
| Medicare PECOS PAC ID | 7214240498 |
|---|---|
| Medicare Enrollment ID | O20150716002210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508252867 | NPI | - | NPPES |
| Z0973A | Other | FL | MEDICARE PTAN |
| Z0937 | Other | FL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW560 (Florida) | Primary |
| Provider Name | Lewis A Fabrick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932108990 PECOS PAC ID: 5698712750 Enrollment ID: I20050411001177 |
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