Basic Information
Provider Information
NPI: 1003149337
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUILLEMETTE
FirstName: LAURA
MiddleName: ANN
NamePrefix: MISS
NameSuffix:  
Credential: M.ED.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 38 HAWTHORNE DR
Address2: UNIT F303
City: BEDFORD
State: NH
PostalCode: 031106895
CountryCode: US
TelephoneNumber: 9782694347
FaxNumber:  
Practice Location
Address1: 15 UNION STREET
Address2: SUITE NUMBER 204
City: LAWRENCE
State: MA
PostalCode: 018401866
CountryCode: US
TelephoneNumber: 9786884830
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/18/2009
LastUpdateDate: 09/18/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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