Provider Demographics
NPI:1841807112
Name:BOURGEOISE, SEAN (MA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:BOURGEOISE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-1589
Mailing Address - Country:US
Mailing Address - Phone:413-233-1478
Mailing Address - Fax:
Practice Address - Street 1:628 CENTER ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1589
Practice Address - Country:US
Practice Address - Phone:413-233-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)