1790769081 NPI number — MR. MARY PATRICIA FRIGIANI R.N. CADC

Table of content: MR. MARY PATRICIA FRIGIANI R.N. CADC (NPI 1790769081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790769081 NPI number — MR. MARY PATRICIA FRIGIANI R.N. CADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIGIANI
Provider First Name:
MARY
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.N. CADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790769081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 NORTHFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06795-1433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-945-3125
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
88 GRANDVIEW AVE
Provider Second Line Business Practice Location Address:
WEST MAIN BEHAVIORAL HEALTH
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06708-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-573-7500
Provider Business Practice Location Address Fax Number:
203-573-6575
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  000123 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163W00000X , with the licence number: E29066 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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