Provider Demographics
NPI:1306019294
Name:BISSONNETTE, THERESE L (LIC AC)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:L
Last Name:BISSONNETTE
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237H STONY FORT RD
Mailing Address - Street 2:
Mailing Address - City:WEST KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02892-1200
Mailing Address - Country:US
Mailing Address - Phone:508-238-5888
Mailing Address - Fax:
Practice Address - Street 1:105 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1100
Practice Address - Country:US
Practice Address - Phone:508-238-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223376171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist