Individual
MS. ANGELA MARIE FONSECA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADCI CAS
Contact information
Practice address
62 WALDECK ST, DORCHESTER CENTER, MA 02124-1329
(617) 265-2636
Mailing address
618 TWIN LAKES DR, HALIFAX, MA 02338-2229
(781) 294-4123
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
MA
Other
Enumeration date
11/08/2011
Last updated
11/08/2011
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