Healthcare Provider Details

I. General information

NPI: 1881417137
Provider Name (Legal Business Name): COLLEEN ROSE CHAGNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FORBES RD STE 250E
BRAINTREE MA
02184-2605
US

IV. Provider business mailing address

191 BUNKER HILL ST APT 306
CHARLESTOWN MA
02129-2556
US

V. Phone/Fax

Practice location:
  • Phone: 617-765-1062
  • Fax: 781-356-9042
Mailing address:
  • Phone: 203-673-1019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: