Provider Demographics
NPI:1205378262
Name:ANSELL, LOUISA T
Entity Type:Individual
Prefix:MS
First Name:LOUISA
Middle Name:T
Last Name:ANSELL
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 1:1 VARY WAY
Mailing Address - Street 2:LINDENCROFT
Mailing Address - City:BERKLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02779
Mailing Address - Country:US
Mailing Address - Phone:508-880-0883
Mailing Address - Fax:508-822-8332
Practice Address - Street 1:1 VARY WAY
Practice Address - Street 2:LINDENCROFT
Practice Address - City:BERKLEY
Practice Address - State:MA
Practice Address - Zip Code:02779
Practice Address - Country:US
Practice Address - Phone:508-880-0883
Practice Address - Fax:508-822-8332
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health