Provider Demographics
NPI:1780187070
Name:DELISLE, PATRICIA F
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:F
Last Name:DELISLE
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 1:40 PEASE AVE
Mailing Address - Street 2:
Mailing Address - City:MONSON
Mailing Address - State:MA
Mailing Address - Zip Code:01057-1411
Mailing Address - Country:US
Mailing Address - Phone:413-218-3097
Mailing Address - Fax:
Practice Address - Street 1:40 PEASE AVE
Practice Address - Street 2:
Practice Address - City:MONSON
Practice Address - State:MA
Practice Address - Zip Code:01057-1411
Practice Address - Country:US
Practice Address - Phone:413-218-3097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health