Provider Demographics
NPI:1801527700
Name:WATERS FRATIANNI, COLLEEN M
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:WATERS FRATIANNI
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 1:10 BOLTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CASTLETON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-1007
Mailing Address - Country:US
Mailing Address - Phone:518-495-1563
Mailing Address - Fax:
Practice Address - Street 1:10 BOLTWOOD AVE
Practice Address - Street 2:
Practice Address - City:CASTLETON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12033-1007
Practice Address - Country:US
Practice Address - Phone:518-495-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency