Healthcare Provider Details

I. General information

NPI: 1265697361
Provider Name (Legal Business Name): MRS. EVANGELINE BRENNAN-KOLISCZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 N MAIN ST SUITE 208
FALL RIVER MA
02720-2983
US

IV. Provider business mailing address

100 CENTRE ST
RUMFORD RI
02916-3144
US

V. Phone/Fax

Practice location:
  • Phone: 508-324-1060
  • Fax: 508-679-8590
Mailing address:
  • Phone: 401-435-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: