Provider Demographics
NPI:1982234621
Name:PACKARD, ALEXIS ELIZABETH (BA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ELIZABETH
Last Name:PACKARD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1456
Mailing Address - Country:US
Mailing Address - Phone:774-364-2834
Mailing Address - Fax:508-756-1040
Practice Address - Street 1:861 SALISBURY ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1456
Practice Address - Country:US
Practice Address - Phone:774-364-2834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor