Individual
FABIOLA CLAUDIA CANCINO TICONA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1 ARCH PL, GREENFIELD, MA 01301-2457
(413) 774-1000
Mailing address
1 ARCH PL, GREENFIELD, MA 01301-2457
(413) 774-1000
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
245385
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110087716A
—
MA
01
—
298878
TUFTS
MA
01
—
P00887159
RAILROAD
MA
Enumeration date
11/18/2009
Last updated
03/31/2017
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