Provider Demographics
NPI:1396040788
Name:FUOCO, IDA MEREDITH (MS)
Entity Type:Individual
Prefix:
First Name:IDA
Middle Name:MEREDITH
Last Name:FUOCO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-4102
Mailing Address - Country:US
Mailing Address - Phone:978-420-6043
Mailing Address - Fax:
Practice Address - Street 1:555 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3906
Practice Address - Country:US
Practice Address - Phone:978-454-2997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor