Individual
DIANNA FULREADER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
29 NORTHWOODS RD, GROTON, MA 01450-1043
(197) 849-6776
Mailing address
29 NORTHWOODS RD, GROTON, MA 01450-1043
(197) 849-6776
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1023399
MA
Other
Enumeration date
09/28/2018
Last updated
09/28/2018
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