Provider Demographics
NPI:1568822294
Name:FAGUNDO, CORINA
Entity Type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:FAGUNDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 HIGH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3128
Mailing Address - Country:US
Mailing Address - Phone:781-475-0844
Mailing Address - Fax:
Practice Address - Street 1:141 HIGH ST APT 2
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3128
Practice Address - Country:US
Practice Address - Phone:781-475-0844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical