Provider Demographics
NPI:1801386693
Name:BOISVERT, TRACENE
Entity Type:Individual
Prefix:
First Name:TRACENE
Middle Name:
Last Name:BOISVERT
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 1:7 LENLOR LN
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01529-1658
Mailing Address - Country:US
Mailing Address - Phone:774-460-0216
Mailing Address - Fax:
Practice Address - Street 1:420 FRUIT HILL AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-2626
Practice Address - Country:US
Practice Address - Phone:401-353-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health