Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MA |
NPI | 1003184250 |
---|---|
Provider Name | Mrs. Moirar M. Leveille |
First Address | Nantucket, MA 02584 |
Second Address | Nantucket, MA 02554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2011 |
Last Update Date | 02/12/2011 |