Provider Demographics
NPI:1841457884
Name:FETTA, FIORIGIO (LPC, NCGC-II)
Entity type:Individual
Prefix:
First Name:FIORIGIO
Middle Name:
Last Name:FETTA
Suffix:
Gender:M
Credentials:LPC, NCGC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:RUSSELL HALL / CVH
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-7023
Mailing Address - Country:US
Mailing Address - Phone:860-262-5984
Mailing Address - Fax:860-344-2360
Practice Address - Street 1:410 CAPITAL AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-262-5984
Practice Address - Fax:860-344-2360
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001691101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional