Provider Demographics
NPI:1952610081
Name:BIGONET, LAILA EVA (LISCW)
Entity Type:Individual
Prefix:
First Name:LAILA EVA
Middle Name:
Last Name:BIGONET
Suffix:
Gender:F
Credentials:LISCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 WASHINGTON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-3141
Mailing Address - Country:US
Mailing Address - Phone:617-480-5683
Mailing Address - Fax:781-235-1433
Practice Address - Street 1:263 WASHINGTON ST STE 1
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-3141
Practice Address - Country:US
Practice Address - Phone:617-480-5683
Practice Address - Fax:781-235-1433
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA1179351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program