Individual
JESSICA FANDINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
472 LONSDALE AVE, PAWTUCKET, RI 02860-1844
(401) 524-1995
Mailing address
472 LONSDALE AVE, PAWTUCKET, RI 02860-1844
(401) 524-1995
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
RI
Enumeration date
05/27/2022
Last updated
07/01/2022
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