Provider Demographics
NPI:1942988647
Name:LAVOIE, MARY-JO
Entity Type:Individual
Prefix:
First Name:MARY-JO
Middle Name:
Last Name:LAVOIE
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 1:1005 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5550
Mailing Address - Country:US
Mailing Address - Phone:774-539-5425
Mailing Address - Fax:
Practice Address - Street 1:1005 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5550
Practice Address - Country:US
Practice Address - Phone:774-539-5425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator