Provider Demographics
NPI:1710113204
Name:ALCOTT, BONNIE (LADCI)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:
Last Name:ALCOTT
Suffix:
Gender:F
Credentials:LADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SANTUIT POND RD
Mailing Address - Street 2:UNIT 1C
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-2443
Mailing Address - Country:US
Mailing Address - Phone:617-626-8859
Mailing Address - Fax:
Practice Address - Street 1:35 SANTUIT POND RD
Practice Address - Street 2:UNIT 1C
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-2443
Practice Address - Country:US
Practice Address - Phone:617-626-8859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2270101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)