Provider Demographics
NPI:1538260351
Name:FRAIOLI, MICHELINA
Entity type:Individual
Prefix:
First Name:MICHELINA
Middle Name:
Last Name:FRAIOLI
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 1:55 LAKE AVENUE NORTH
Mailing Address - Street 2:UMASS MEMORIAL MEDICAL CENTER, PSYCHIATRY
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655
Mailing Address - Country:US
Mailing Address - Phone:508-334-3562
Mailing Address - Fax:508-421-1000
Practice Address - Street 1:55 LAKE AVENUE NORTH
Practice Address - Street 2:UMASS MEMORIAL MEDICAL CENTER, PSYCHIATRY
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655
Practice Address - Country:US
Practice Address - Phone:508-334-3562
Practice Address - Fax:508-421-1000
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1119601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23442Medicare PIN