Individual
SELENE FABIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
8945 GOLF LINKS RD, OAKLAND, CA 94605-4124
(510) 504-6836
(510) 343-2175
Mailing address
8945 GOLF LINKS RD, OAKLAND, CA 94605-4124
(510) 504-6836
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY 14541
CA
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY14541
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ22806Z
MEDICARE - GROUP PIN
CA
Enumeration date
09/25/2006
Last updated
12/29/2022
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