Basic Information
| Provider Information | |||||||||
| NPI: | 1619376712 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FRANDY MATHIEU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 COLUMBUS AVE FL 1 | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028604516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016586922 | ||||||||
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| Practice Location | |||||||||
| Address1: | 520 DUDLEY ST | ||||||||
| Address2: | |||||||||
| City: | ROXBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021192769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179899499 | ||||||||
| FaxNumber: | 6174452672 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2014 | ||||||||
| LastUpdateDate: | 08/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | MATHIEU | ||||||||
| AuthorizedOfficialFirstName: | FRANDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 4016586922 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.S. ED | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.