Provider Demographics
NPI:1902037278
Name:BLANCHETTE, PATRICE A (RN, LMHC)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:A
Last Name:BLANCHETTE
Suffix:
Gender:F
Credentials:RN, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-4868
Mailing Address - Country:US
Mailing Address - Phone:978-886-0925
Mailing Address - Fax:978-470-1593
Practice Address - Street 1:3 DUNDEE PARK DR
Practice Address - Street 2:SUITE 202A
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3751
Practice Address - Country:US
Practice Address - Phone:978-684-2823
Practice Address - Fax:978-470-1593
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA147931163WP0809X
MA7169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
12217924OtherCAQH