Healthcare Provider Details

I. General information

NPI: 1760785166
Provider Name (Legal Business Name): MELISSA LEIGH FIJOL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N MAIN ST
WHITINSVILLE MA
01588-1835
US

IV. Provider business mailing address

160 N MAIN ST
WHITINSVILLE MA
01588-1835
US

V. Phone/Fax

Practice location:
  • Phone: 617-755-1379
  • Fax:
Mailing address:
  • Phone: 617-755-1379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: