Basic Information
| Provider Information | |||||||||
| NPI: | 1972673259 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRISOLI | ||||||||
| FirstName: | JULIANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 675 PARAMOUNT DR | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | RAYNHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027675416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088806868 | ||||||||
| FaxNumber: | 5088809848 | ||||||||
| Practice Location | |||||||||
| Address1: | 675 PARAMOUNT DRIVE | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | RAYNHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027671433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088806868 | ||||||||
| FaxNumber: | 5088809848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 05/21/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1026347 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1852132 | 05 | MA | MEDICAID |