Provider Demographics
NPI:1407914435
Name:BACOTTI, ALFRED VICTOR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:VICTOR
Last Name:BACOTTI
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 1:61 HUNTING AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3171
Mailing Address - Country:US
Mailing Address - Phone:508-842-1223
Mailing Address - Fax:
Practice Address - Street 1:420 BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3464
Practice Address - Country:US
Practice Address - Phone:508-842-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4443103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist