Provider Demographics
NPI:1881265684
Name:FENOCHETTI, MATHEW JAMES (MT)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:JAMES
Last Name:FENOCHETTI
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-1669
Mailing Address - Country:US
Mailing Address - Phone:978-835-2175
Mailing Address - Fax:
Practice Address - Street 1:155 DOW ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1299
Practice Address - Country:US
Practice Address - Phone:978-835-2175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7247163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)