Provider Demographics
NPI:1396428371
Name:LAKE, ABBEY NOEL
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:NOEL
Last Name:LAKE
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 1:19 QUOBAUG AVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01540-2118
Mailing Address - Country:US
Mailing Address - Phone:508-688-7574
Mailing Address - Fax:
Practice Address - Street 1:9 VILLAGE INN RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473-1643
Practice Address - Country:US
Practice Address - Phone:978-571-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health