Provider Demographics
NPI:1225315765
Name:FANELLI, JUDITH (LMT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:FANELLI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:850 HIGH ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-3739
Mailing Address - Country:US
Mailing Address - Phone:413-536-0142
Mailing Address - Fax:413-536-0607
Practice Address - Street 1:155 MAPLE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-2649
Practice Address - Country:US
Practice Address - Phone:413-285-8060
Practice Address - Fax:413-285-8061
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA9841225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist