Provider Demographics
NPI:1700514890
Name:CORMIER, CHERIE LYN
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:LYN
Last Name:CORMIER
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 1:243 CLEMENCE HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-3415
Mailing Address - Country:US
Mailing Address - Phone:508-365-7532
Mailing Address - Fax:
Practice Address - Street 1:42 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1937
Practice Address - Country:US
Practice Address - Phone:774-318-1806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician