Provider Demographics
NPI:1265739791
Name:VAILLANCOURT, MAEVE L (MA)
Entity type:Individual
Prefix:MS
First Name:MAEVE
Middle Name:L
Last Name:VAILLANCOURT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GUNNING CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5814
Mailing Address - Country:US
Mailing Address - Phone:401-835-5238
Mailing Address - Fax:
Practice Address - Street 1:71 GRACE ST
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-2034
Practice Address - Country:US
Practice Address - Phone:401-871-7846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health