Robert Daniel Fairbanks, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

5601284-3501 Issued in UT

Practice address

200 N Anderson LN
Lindon, UT 84042-1110

Phone

(801) 785-1761

NPI assigned

Aug 18, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434499200000",
    "number": "1164702445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N ANDERSON LN",
            "city": "LINDON",
            "state": "UT",
            "postal_code": "840421110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N ANDERSON LN",
            "city": "LINDON",
            "state": "UT",
            "postal_code": "840421110",
            "telephone_number": "801-785-1761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBANKS",
        "first_name": "ROBERT",
        "middle_name": "DANIEL",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-18",
        "last_updated": "2015-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "UT",
            "license": "56012843502",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "5601284-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abbet L Elison, LMT
• Era Dermatology
• Mary Malissa Errazo
• Sabrina Celeste Esplin, MS, AMFT
• Chelsey Alana Evans, RDN
• Jordan Gale Farnsworth
• Theodore Feesago
• Leimoni Feinga
• Subhashini Y Fernando
• Geoffrey Thomas Fisher, OTR/L

• Clinical Social Worker in Lindon, UT
• Providers in Lindon, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.