=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033791561
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HELENA E GAGNON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2021
-----------------------------------------------------
Last Update Date | 04/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 304 W MAIN ST
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06001-4355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-486-0981
-----------------------------------------------------
Fax | 413-707-1032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 440 GRAYSON DR
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01119-1648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-210-8263
-----------------------------------------------------
Fax | 413-707-1032
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | MRS. HELENA E GAGNON
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 413-210-8263
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------