=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366308728
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HETSRON NEPHEG ALEXANDRE COUNSELOR
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2025
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 231 MAIN ST FL 3
-----------------------------------------------------
City | BROCKTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02301-4342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-586-2660
-----------------------------------------------------
Fax | 508-492-2963
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42 GEORDAN AVE
-----------------------------------------------------
City | WRENTHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02093-1121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-663-3852
-----------------------------------------------------
Fax | 508-492-2963
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------