Healthcare Provider Details

I. General information

NPI: 1700514890
Provider Name (Legal Business Name): CHERIE LYN CORMIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 OPTICAL DR FL 3
SOUTHBRIDGE MA
01550-2559
US

IV. Provider business mailing address

7 CEDAR ST PO BOX 252
SOUTH BARRE MA
01074
US

V. Phone/Fax

Practice location:
  • Phone: 508-519-3590
  • Fax:
Mailing address:
  • Phone: 508-365-7532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: