Provider Demographics
NPI:1639199086
Name:ARCHAMBAULT, DENISE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:ARCHAMBAULT
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 1:53 EVELYN ST
Mailing Address - Street 2:
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3409
Mailing Address - Country:US
Mailing Address - Phone:401-228-4387
Mailing Address - Fax:774-202-7469
Practice Address - Street 1:53 EVELYN ST
Practice Address - Street 2:
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3409
Practice Address - Country:US
Practice Address - Phone:401-228-4387
Practice Address - Fax:774-202-7469
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW003111041C0700X
MA1080371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0004469Medicare UPIN
RI809003769Medicare PIN