Healthcare Provider Details

I. General information

NPI: 1295894947
Provider Name (Legal Business Name): RICHARD FRIGAULT LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 BEDFORD ST
WHITMAN MA
02382-1820
US

IV. Provider business mailing address

PO BOX 529
SAGAMORE BEACH MA
02562-0529
US

V. Phone/Fax

Practice location:
  • Phone: 508-888-1587
  • Fax:
Mailing address:
  • Phone: 508-888-1587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104117
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: