Provider Demographics
NPI:1962578799
Name:CIPPOLETTI, CONCETTA (LMT)
Entity type:Individual
Prefix:MRS
First Name:CONCETTA
Middle Name:
Last Name:CIPPOLETTI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CONCETTA
Other - Middle Name:
Other - Last Name:CIPPOLETTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:10430
Mailing Address - Street 1:321 FORTUNE BLVD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1750
Mailing Address - Country:US
Mailing Address - Phone:508-478-0207
Mailing Address - Fax:508-634-6984
Practice Address - Street 1:321 FORTUNE BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1750
Practice Address - Country:US
Practice Address - Phone:508-478-0207
Practice Address - Fax:508-634-6984
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10430174400000X, 246Y00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No174400000XOther Service ProvidersSpecialist
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information