Basic Information
| Provider Information | |||||||||
| NPI: | 1841840063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUNELLE | ||||||||
| FirstName: | PAULINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 RODMAN RD | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017211913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087335607 | ||||||||
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| Practice Location | |||||||||
| Address1: | 324 CLARK ST REAR 2 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016061214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087914976 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2019 | ||||||||
| LastUpdateDate: | 09/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.