Healthcare Provider Details

I. General information

NPI: 1831053248
Provider Name (Legal Business Name): MS. LAURA GABRIELLA DESOUZA PEIXOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HARTWELL ST
WEST BOYLSTON MA
01583-2409
US

IV. Provider business mailing address

19 MALBURN TER
LEOMINSTER MA
01453-4820
US

V. Phone/Fax

Practice location:
  • Phone: 508-835-2800
  • Fax:
Mailing address:
  • Phone: 508-903-7453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: