Basic Information
Provider Information
NPI: 1508891771
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COURNOYER
FirstName: RODNEY
MiddleName: P
NamePrefix: MR.
NameSuffix:  
Credential: MSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 40 WRIGHT STREET
Address2:  
City: PALMER
State: MA
PostalCode: 01069
CountryCode: US
TelephoneNumber: 4132837651
FaxNumber: 4132845117
Practice Location
Address1: 40 WRIGHT STREET
Address2: WING MEMORIAL HOSPITAL GRISWOLD CENTER
City: PALMER
State: MA
PostalCode: 01069
CountryCode: US
TelephoneNumber: 4132845285
FaxNumber: 4132845384
Other Information
ProviderEnumerationDate: 07/12/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X1020656MAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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