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General NPI Number Information
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NPI Number | 1235287400
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Entity Type | Individual
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Provider Name | PAMELA FANTINI PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 20 CENTRAL ST
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City | SALEM
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State | MA
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Zip | 01970-3739
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Country | US
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Telephone | 781-639-2359
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Fax | 978-745-5455
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Provider Business Mailing Address
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Address Line | 7 MILL POND
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City | MARBLEHEAD
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State | MA
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Zip | 01945-2686
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Country | US
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Telephone | 781-639-2359
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Fax | 978-745-5455
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY4599
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License Number State | MA
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