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NPI Code Detail

MEDICARE: DR. NANCY J. FREDINE PH.D.

MEDICARE:  DR. NANCY J. FREDINE  PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist002920CT

General Provider Information

NPI Number : 1780985705
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NANCY J. FREDINE PH.D.
Provider Business Mailing Address
First Line : 410 STATE ST
Second Line : #14
City : NORTH HAVEN
State : CT
Zip : 06473-3147
Country : US
Telephone Number : 203-376-7443
Fax Number :
Provider Business Practice Location Address
First Line : 410 STATE ST
Second Line : #14
City : NORTH HAVEN
State : CT
Zip : 06473-3147
Country : US
Telephone Number : 203-376-7443
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2010
Last Update Date : 11/08/2010

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