Provider Demographics
NPI:1316901911
Name:FEDELE, NICOLINA MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLINA
Middle Name:MARIE
Last Name:FEDELE
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 1:36 STONEBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3023
Mailing Address - Country:US
Mailing Address - Phone:508-655-4517
Mailing Address - Fax:508-655-4517
Practice Address - Street 1:36 STONEBRIDGE RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-3023
Practice Address - Country:US
Practice Address - Phone:508-655-4517
Practice Address - Fax:508-655-4517
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA718017OtherTUFTS
MA644665OtherHPHC
MAW03457OtherBCBS
MAW03457OtherBCBS