Provider Demographics
NPI:1639815475
Name:BONHEUR, NATHALIE ALEXANDRA
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:ALEXANDRA
Last Name:BONHEUR
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 1:49 COYLE AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-1132
Mailing Address - Country:US
Mailing Address - Phone:862-321-9281
Mailing Address - Fax:
Practice Address - Street 1:231 MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4342
Practice Address - Country:US
Practice Address - Phone:508-586-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health