Healthcare Provider Details

I. General information

NPI: 1841766730
Provider Name (Legal Business Name): CARISSA M DAGENAIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 ATWOOD DR STE 301
NORTHAMPTON MA
01060-4266
US

IV. Provider business mailing address

15 WILLIAMS ST
NORTHAMPTON MA
01060-3385
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-1314
  • Fax:
Mailing address:
  • Phone: 413-336-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: