Provider Demographics
NPI:1306368444
Name:DEBEAUCOURT, BONNY C (CASE MANAGER)
Entity Type:Individual
Prefix:MRS
First Name:BONNY
Middle Name:C
Last Name:DEBEAUCOURT
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:MISS
Other - First Name:BONNY
Other - Middle Name:C
Other - Last Name:BOUTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CASE MANAGER
Mailing Address - Street 1:6 CRIMSON CT
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-4756
Mailing Address - Country:US
Mailing Address - Phone:508-521-2287
Mailing Address - Fax:508-580-5162
Practice Address - Street 1:80 ERDMAN WAY # 208
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1840
Practice Address - Country:US
Practice Address - Phone:978-870-1840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health