Provider Demographics
NPI:1558787879
Name:OUELLETTE, LONNIE RAE (LABA)
Entity Type:Individual
Prefix:MRS
First Name:LONNIE
Middle Name:RAE
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 SCHOOL HOUSE LANE
Mailing Address - Street 2:
Mailing Address - City:BOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01719
Mailing Address - Country:US
Mailing Address - Phone:978-314-3647
Mailing Address - Fax:
Practice Address - Street 1:62 SCHOOL HOUSE LANE
Practice Address - Street 2:
Practice Address - City:BOXBORO
Practice Address - State:MA
Practice Address - Zip Code:01719
Practice Address - Country:US
Practice Address - Phone:978-314-3647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA279736101YS0200X
MA000001638103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool