Provider Demographics
NPI:1669526323
Name:FULGINITI, VALERIE
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:FULGINITI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:HENKEL
Other - Last Name:STOCKDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:301 N.W.MAIN STREET
Mailing Address - Street 2:PO BOX 242
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516
Mailing Address - Country:US
Mailing Address - Phone:508-752-5880
Mailing Address - Fax:508-831-9967
Practice Address - Street 1:338 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-2143
Practice Address - Country:US
Practice Address - Phone:508-752-5880
Practice Address - Fax:508-831-9967
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health