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NPI Code Detail

MEDICARE: GABRIELLE RANCOURT

MEDICARE: GABRIELLE RANCOURT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst80MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1103K00000XOTHERMABEHAVIOR ANALYST

General Provider Information

NPI Number : 1306162391
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIELLE RANCOURT
Provider Business Mailing Address
First Line : 11 DONAMOR LN
Second Line :
City : EAST LONGMEADOW
State : MA
Zip : 01028-2219
Country : US
Telephone Number : 413-281-9902
Fax Number :
Provider Business Practice Location Address
First Line : 59 INTERSTATE DR
Second Line :
City : WEST SPRINGFIELD
State : MA
Zip : 01089-5100
Country : US
Telephone Number : 774-573-0256
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2010
Last Update Date : 10/03/2017

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Directions to “ GABRIELLE RANCOURT ” Practice Location

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