Provider Demographics
NPI:1215054135
Name:QUILICI MATTEUCCI, FULVIA (PHD)
Entity type:Individual
Prefix:DR
First Name:FULVIA
Middle Name:
Last Name:QUILICI MATTEUCCI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045-2701
Mailing Address - Country:US
Mailing Address - Phone:617-251-3273
Mailing Address - Fax:617-522-0956
Practice Address - Street 1:7 HARRIS AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-2888
Practice Address - Country:US
Practice Address - Phone:617-522-0506
Practice Address - Fax:617-522-0956
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7769103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1037340OtherBEACON HEALTH STRAT. NHP
MAW05957OtherBLUE CROSS BLUE SHIELD MA
MAW05957OtherBLUE CROSS BLUE SHIELD MA