Provider Demographics
NPI:1225662323
Name:FRUZZETTI, ALAN ERIC (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ERIC
Last Name:FRUZZETTI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BELFRY TER
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4909
Mailing Address - Country:US
Mailing Address - Phone:775-338-0152
Mailing Address - Fax:
Practice Address - Street 1:115 MILL STREET
Practice Address - Street 2:MCLEAN HOSPITAL
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-0247
Practice Address - Country:US
Practice Address - Phone:617-855-4394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11274103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical