Provider Demographics
NPI:1700988425
Name:FEDERICI, EDWARD JAMES (LMFT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JAMES
Last Name:FEDERICI
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SILAS DEANE HWY
Mailing Address - Street 2:SUITE 26
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1327
Mailing Address - Country:US
Mailing Address - Phone:860-402-2090
Mailing Address - Fax:
Practice Address - Street 1:1800 SILAS DEANE HWY
Practice Address - Street 2:SUITE 26
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1327
Practice Address - Country:US
Practice Address - Phone:860-402-2090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000684106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist