Provider Demographics
NPI:1285221275
Name:JOLICOEUR, KATHLEEN M (BSPH)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:JOLICOEUR
Suffix:
Gender:F
Credentials:BSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 E ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2141
Mailing Address - Country:US
Mailing Address - Phone:774-240-5958
Mailing Address - Fax:
Practice Address - Street 1:386 E ASHLAND ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2141
Practice Address - Country:US
Practice Address - Phone:774-240-5958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician