Individual
MICHAEL LOUIS FIDALGO-PENNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
321 FORTUNE BLVD, MILFORD, MA 01757-1750
(508) 478-0207
Mailing address
92 AVERY ST, SPRINGFIELD, MA 01119-1106
(413) 867-8710
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
MA
222Q00000X
Developmental Therapist
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
Other
Enumeration date
10/27/2020
Last updated
06/02/2022
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