Healthcare Provider Details

I. General information

NPI: 1568274413
Provider Name (Legal Business Name): JULIANNE FAHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 UNION ST
WORCESTER MA
01608-1141
US

IV. Provider business mailing address

3 CASEY ST
SPENCER MA
01562-2503
US

V. Phone/Fax

Practice location:
  • Phone: 617-308-0945
  • Fax:
Mailing address:
  • Phone: 774-289-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

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: