Provider Demographics
NPI:1578759692
Name:BOISSONEAU, SUZANNE A (MED)
Entity Type:Individual
Prefix:MISS
First Name:SUZANNE
Middle Name:A
Last Name:BOISSONEAU
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-6112
Mailing Address - Country:US
Mailing Address - Phone:508-965-3477
Mailing Address - Fax:
Practice Address - Street 1:1563 N MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2983
Practice Address - Country:US
Practice Address - Phone:508-324-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor