Provider Demographics
NPI:1932333010
Name:FORTUNATO, CHRISTOPHER MICHAEL (JD, LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:FORTUNATO
Suffix:
Gender:M
Credentials:JD, LCSW
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 LN
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-7907
Mailing Address - Country:US
Mailing Address - Phone:508-877-7013
Mailing Address - Fax:
Practice Address - Street 1:PROVIDENCE COLLEGE
Practice Address - Street 2:1 CUNNINGHAM SQUARE
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02918-0001
Practice Address - Country:US
Practice Address - Phone:401-865-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2153361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical