Healthcare Provider Details

I. General information

NPI: 1902037278
Provider Name (Legal Business Name): PATRICE A. BLANCHETTE RN, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 DUNDEE PARK DR SUITE 202A
ANDOVER MA
01810-3751
US

IV. Provider business mailing address

65 ANDOVER ST
ANDOVER MA
01810-4868
US

V. Phone/Fax

Practice location:
  • Phone: 978-684-2823
  • Fax: 978-470-1593
Mailing address:
  • Phone: 978-886-0925
  • Fax: 978-470-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number147931
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7169
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: