Healthcare Provider Details

I. General information

NPI: 1144154386
Provider Name (Legal Business Name): DIANE POULIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 FOXBOROUGH BLVD STE 201
FOXBORO MA
02035-3062
US

IV. Provider business mailing address

550 S MAIN ST APT 2
WOONSOCKET RI
02895-5745
US

V. Phone/Fax

Practice location:
  • Phone: 508-901-4685
  • Fax:
Mailing address:
  • Phone: 401-649-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: