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General NPI Number Information
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NPI Number | 1407157993
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Entity Type | Individual
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Provider Name | CHANTAL SYLVIE PELOQUIN M.A., LMHC
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Gender | Female
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 101 ARCH ST FL 8
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City | BOSTON
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State | MA
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Zip | 02110-7500
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Country | US
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Telephone | 978-273-3396
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Fax |
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Provider Business Mailing Address
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Address Line | 19 PRENTICE ST
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City | SPRINGFIELD
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State | MA
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Zip | 01104-2215
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Country | US
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Telephone | 413-222-8819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8175
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License Number State | MA
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