Healthcare Provider Details

I. General information

NPI: 1528146701
Provider Name (Legal Business Name): LYNNE A PELOQUIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNNE A PELOQUIN-BARAIOLO

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 VALERIE DR
PLAINVILLE MA
02762-1408
US

IV. Provider business mailing address

23 VALERIE DR
PLAINVILLE MA
02762-1408
US

V. Phone/Fax

Practice location:
  • Phone: 508-695-0985
  • Fax:
Mailing address:
  • Phone: 508-695-0985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105585
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: