Provider Demographics
NPI:1457643777
Name:FEDERICI, GINO N
Entity Type:Individual
Prefix:MR
First Name:GINO
Middle Name:N
Last Name:FEDERICI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3469
Mailing Address - Country:US
Mailing Address - Phone:508-942-7365
Mailing Address - Fax:
Practice Address - Street 1:129 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-3529
Practice Address - Country:US
Practice Address - Phone:401-965-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker