Provider Demographics
NPI:1073298212
Name:TOURANGEAU, MARY ALICE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ALICE
Last Name:TOURANGEAU
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 1:230 SPRING STREET
Mailing Address - Street 2:APT 2
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770
Mailing Address - Country:US
Mailing Address - Phone:203-887-6445
Mailing Address - Fax:
Practice Address - Street 1:230 SPRING STREET
Practice Address - Street 2:APT 2
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770
Practice Address - Country:US
Practice Address - Phone:203-887-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst