Provider Demographics
NPI:1043791296
Name:CONNOLE, REBECCA F
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:F
Last Name:CONNOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2207
Mailing Address - Country:US
Mailing Address - Phone:617-710-0848
Mailing Address - Fax:
Practice Address - Street 1:28 SHERWOOD AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2720
Practice Address - Country:US
Practice Address - Phone:508-841-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-26
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1119861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical