Provider Demographics
NPI:1508568650
Name:DUTILE, SHAUN (MA, PC)
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:
Last Name:DUTILE
Suffix:
Gender:M
Credentials:MA, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 WHITE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-1934
Mailing Address - Country:US
Mailing Address - Phone:603-366-8727
Mailing Address - Fax:
Practice Address - Street 1:137 WHITE OAKS RD
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-1934
Practice Address - Country:US
Practice Address - Phone:603-366-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional