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General NPI Number Information
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NPI Number | 1447093737
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Entity Type | Individual
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Provider Name | ANTOINETTE MAILLOUX PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/14/2024
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 7 EXCHANGE ST
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City | BARRE
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State | MA
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Zip | 01005-8726
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Country | US
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Telephone | 978-285-9187
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Fax | 508-213-3982
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Provider Business Mailing Address
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Address Line | PO BOX 21
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City | BARRE
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State | MA
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Zip | 01005-0021
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Country | US
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Telephone | 978-285-9187
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Fax | 508-213-3982
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2294727
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License Number State | MA
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