Provider Demographics
NPI:1437655198
Name:NOGUEIRA, PATRICE
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:NOGUEIRA
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 1:2 NEW BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5624
Mailing Address - Country:US
Mailing Address - Phone:508-979-4058
Mailing Address - Fax:
Practice Address - Street 1:2 NEW BOSTON RD
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-5624
Practice Address - Country:US
Practice Address - Phone:508-979-4058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA149629101YS0200X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool