Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TR0400X | Rehabilitation Psychologist | 230969 | MA |
NPI | 1720684830 |
---|---|
Provider Name | Chantal Cesaire |
First Address | Brockton, MA 02301-6961 |
Second Address | Brockton, MA 02301-6961 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2020 |
Last Update Date | 05/12/2020 |