Provider Demographics
NPI:1679167837
Name:BONNEAU-SAMSON, LOUISE KHASSANDRHA
Entity Type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:KHASSANDRHA
Last Name:BONNEAU-SAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LOUISE
Other - Middle Name:KHASSANDRHA
Other - Last Name:BONNEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-1715
Mailing Address - Country:US
Mailing Address - Phone:617-412-7844
Mailing Address - Fax:
Practice Address - Street 1:109 OAK ST STE G30
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1492
Practice Address - Country:US
Practice Address - Phone:617-658-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician