Healthcare Provider Details

I. General information

NPI: 1790649101
Provider Name (Legal Business Name): CLIFF FONTANEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER ST
CHICOPEE MA
01013-2680
US

IV. Provider business mailing address

PO BOX 791
HOLYOKE MA
01041-0791
US

V. Phone/Fax

Practice location:
  • Phone: 413-534-0411
  • Fax: 413-538-5169
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: