Provider Demographics
NPI:1013335611
Name:PETTIROSSI, FEDERICA
Entity Type:Individual
Prefix:
First Name:FEDERICA
Middle Name:
Last Name:PETTIROSSI
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:VIA SAN MARTINO 21
Mailing Address - Street 2:
Mailing Address - City:ASSISI
Mailing Address - State:PERUGIA
Mailing Address - Zip Code:06081
Mailing Address - Country:IT
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:271 FINCH AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2715
Practice Address - Country:US
Practice Address - Phone:203-237-8084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004160941Medicaid
CT2600002357C-01560Medicare PIN