Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 114103 | MA |
N | 101YS0200X | School Counselor | 425199 | MA |
NPI | 1205996279 |
---|---|
Provider Name | Ms. Nicole Diane Bonneau |
First Address | Reading, MA 01867-2973 |
Second Address | Reading, MA 01867-2973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 01/09/2010 |