Provider Demographics
NPI:1083861793
Name:IGNACE, FREDO (MA)
Entity Type:Individual
Prefix:
First Name:FREDO
Middle Name:
Last Name:IGNACE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MAURY LN
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-4326
Mailing Address - Country:US
Mailing Address - Phone:774-262-0603
Mailing Address - Fax:
Practice Address - Street 1:73 MAURY LN
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-4326
Practice Address - Country:US
Practice Address - Phone:774-262-0603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker