Basic Information
| Provider Information | |||||||||
| NPI: | 1306173570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FULCHINO | ||||||||
| FirstName: | ELVIRA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MS.OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 49 WALNUT ST BLDG 3 | ||||||||
| Address2: | |||||||||
| City: | WELLESLEY HILLS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024812108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812390100 | ||||||||
| FaxNumber: | 7812390102 | ||||||||
| Practice Location | |||||||||
| Address1: | 49 WALNUT ST. BUILDING 3 | ||||||||
| Address2: | |||||||||
| City: | WELLESLEY HILLS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812390100 | ||||||||
| FaxNumber: | 7812390102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2009 | ||||||||
| LastUpdateDate: | 11/10/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 104828 | MA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 225XP0200X | 8036 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.