Provider Demographics
NPI:1619319852
Name:FODERINGHAM, DEBORAH ANN
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:FODERINGHAM
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 1:3610 MYSTIC VALLEY PKWY
Mailing Address - Street 2:N1413
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5757
Mailing Address - Country:US
Mailing Address - Phone:781-396-1382
Mailing Address - Fax:
Practice Address - Street 1:3610 MYSTIC VALLEY PKWY
Practice Address - Street 2:N1413
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5757
Practice Address - Country:US
Practice Address - Phone:781-396-1382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling