Individual
BLAISE FORTUNATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGIST
Contact information
Practice address
460 W MAIN ST, HYANNIS, MA 02601-3855
(508) 790-3360
(508) 790-3378
Mailing address
460 W MAIN ST, HYANNIS, MA 02601-3855
(508) 790-3360
(508) 790-3378
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
8563
MA
Other
Enumeration date
06/07/2006
Last updated
12/30/2021
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