Healthcare Provider Details

I. General information

NPI: 1306737861
Provider Name (Legal Business Name): MISS CORINNE NOELLE FRATUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 NORTH AVE STE 82A
WAKEFIELD MA
01880-1687
US

IV. Provider business mailing address

599 NORTH AVE STE 82A
WAKEFIELD MA
01880-1687
US

V. Phone/Fax

Practice location:
  • Phone: 781-328-1904
  • Fax: 781-328-4733
Mailing address:
  • Phone: 781-328-1904
  • Fax: 781-328-4733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: