Provider Demographics
NPI:1376024422
Name:LABOSSIERE, JOANNE MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARIE
Last Name:LABOSSIERE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MERCANTILE ST STE 610
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-3103
Mailing Address - Country:US
Mailing Address - Phone:508-334-2582
Mailing Address - Fax:508-334-3070
Practice Address - Street 1:1 MERCANTILE ST STE 610
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-3103
Practice Address - Country:US
Practice Address - Phone:508-334-2582
Practice Address - Fax:508-334-3070
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1078641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical