Healthcare Provider Details

I. General information

NPI: 1790769081
Provider Name (Legal Business Name): MARY PATRICIA FRIGIANI R.N. CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 GRANDVIEW AVE WEST MAIN BEHAVIORAL HEALTH
WATERBURY CT
06708-2509
US

IV. Provider business mailing address

1020 NORTHFIELD RD
WATERTOWN CT
06795-1433
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-7500
  • Fax: 203-573-6575
Mailing address:
  • Phone: 860-945-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000123
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberE29066
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: