Provider Demographics
NPI:1003184250
Name:LEVEILLE, MOIRAR M (MASTERS INTERN MHC)
Entity Type:Individual
Prefix:MRS
First Name:MOIRAR
Middle Name:M
Last Name:LEVEILLE
Suffix:
Gender:F
Credentials:MASTERS INTERN MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 2895
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02584
Mailing Address - Country:US
Mailing Address - Phone:508-615-1885
Mailing Address - Fax:508-228-3613
Practice Address - Street 1:20 VESPER LANE L-1
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554
Practice Address - Country:US
Practice Address - Phone:508-228-2689
Practice Address - Fax:508-228-3613
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health