Provider Demographics
NPI:1134513468
Name:VITTORIOSO FORTIN, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:VITTORIOSO FORTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-3540
Mailing Address - Country:US
Mailing Address - Phone:617-997-1063
Mailing Address - Fax:
Practice Address - Street 1:42 RIVER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-3540
Practice Address - Country:US
Practice Address - Phone:617-997-1063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty