Healthcare Provider Details

I. General information

NPI: 1255748141
Provider Name (Legal Business Name): MS. PAMELA FRECHETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA JOSEPH RN

II. Dates (important events)

Enumeration Date: 07/13/2014
Last Update Date: 07/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 QUINCY AVE ADULT COMMUNITY CRISIS STABILIZATION UNIT
QUINCY MA
02169-8130
US

IV. Provider business mailing address

460 QUINCY AVE ADULT COMMUNITY CRISIS STABILIZATION UNIT
QUINCY MA
02169-8130
US

V. Phone/Fax

Practice location:
  • Phone: 617-847-1950
  • Fax: 617-774-1490
Mailing address:
  • Phone: 617-847-1950
  • Fax: 617-774-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN235262
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberRN235262
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: