Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 104100000X | Social Worker | 000225696 | MA |
NPI | 1003390931 |
---|---|
Provider Name | Rebecca Lynn Bibeault |
First Address | Methuen, MA 01844-4297 |
Second Address | Methuen, MA 01844-4297 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2018 |
Last Update Date | 09/03/2020 |