Basic Information
| Provider Information | |||||||||
| NPI: | 1598177388 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOUSSEAU | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46 WIMBLEDON XING | ||||||||
| Address2: | |||||||||
| City: | DRACUT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018266320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9788663159 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 WASHINGTON ST STE 303 | ||||||||
| Address2: | |||||||||
| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021844768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818433683 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2014 | ||||||||
| LastUpdateDate: | 05/28/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.