Basic Information
| Provider Information | |||||||||
| NPI: | 1376998302 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPILLMAN | ||||||||
| FirstName: | CORA | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 15 SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017492205 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 41 MALL RD | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018052205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817448085 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2016 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 12006 | MA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 252Y00000X | N | Agencies | Early Intervention Provider Agency | 101YM0800X | 12006 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.