Provider Demographics
NPI:1326115957
Name:POULIN, NANCIELLEN LAURAH (LMHC)
Entity Type:Individual
Prefix:
First Name:NANCIELLEN
Middle Name:LAURAH
Last Name:POULIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5369
Mailing Address - Country:US
Mailing Address - Phone:413-499-0412
Mailing Address - Fax:413-499-0995
Practice Address - Street 1:333 EAST ST
Practice Address - Street 2:BRIEN CENTER
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5312
Practice Address - Country:US
Practice Address - Phone:413-499-0412
Practice Address - Fax:413-499-0979
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6084101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA33578OtherHEALTH NEW ENGLAND