Provider Demographics
NPI:1285835363
Name:QUEENEY, PATRICIA ALICIA
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ALICIA
Last Name:QUEENEY
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 1:28 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-3235
Mailing Address - Country:US
Mailing Address - Phone:781-848-7177
Mailing Address - Fax:
Practice Address - Street 1:28 RIVER ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-3235
Practice Address - Country:US
Practice Address - Phone:781-848-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1100327174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
380254OtherBLUE CROSS
670063OtherTUFT HEALTH PLAN
702225OtherHARVARD
670063OtherTUFT HEALTH PLAN