Provider Demographics
NPI:1104018613
Name:PARADIS, COLLEEN MARY (MA)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARY
Last Name:PARADIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1066 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-1335
Mailing Address - Country:US
Mailing Address - Phone:508-450-1830
Mailing Address - Fax:
Practice Address - Street 1:172 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3750
Practice Address - Country:US
Practice Address - Phone:508-770-0511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor