| Doctor Name: | DR. NICOLINA MARIE FEDELE |
| NPI Number: | 1316901911 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 3522 |
| Business Practice Address: | 36 Stonebridge Rd Wayland, MA - 017783023 |
| Business Phone Number: | 5086554517 |
| Business Fax Number: | 5086554517 |
| Mailing Address: | 36 Stonebridge Rd, WAYLAND |
| State: | MA |
| Postal Code: | 017783023 |
| Phone Number: | 5086554517 |
| Fax Number: | 5086554517 |
| NPI Enumeration Date: | 04/12/2006 |
| NPI Last Update Date: | 10/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 3522 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |