Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 217179 | MA |
NPI | 1003218017 |
---|---|
Provider Name | Christine Boisvert |
First Address | Brockton, MA 02302-3114 |
Second Address | Brockton, MA 02302-3114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2014 |
Last Update Date | 22/09/2014 |