Provider Demographics
NPI:1265663231
Name:FRATICELLI, DANIEL DAVID I (PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:DAVID
Last Name:FRATICELLI
Suffix:I
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:LA ALHAMBRA
Mailing Address - Street 2:GRANADA STREET #2115
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-461-7518
Mailing Address - Fax:
Practice Address - Street 1:16 CALLE WILLIE ROSARIO
Practice Address - Street 2:SUITE 2
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-3217
Practice Address - Country:US
Practice Address - Phone:787-461-7518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR3224103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist