Healthcare Provider Details

I. General information

NPI: 1922411842
Provider Name (Legal Business Name): LINDA BLOUINROY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MAPLE ST
SPRINGFIELD MA
01105-1864
US

IV. Provider business mailing address

117 GRANDVIEW AVE
WEST SPRINGFIELD MA
01089-1814
US

V. Phone/Fax

Practice location:
  • Phone: 413-304-2908
  • Fax:
Mailing address:
  • Phone:
  • 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: