=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467050534
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VERONICA GRACE LEBEAU-BUSHEE LADC1, CADC1
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2020
-----------------------------------------------------
Last Update Date | 10/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34 SALEM END RD APT 19B
-----------------------------------------------------
City | FRAMINGHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01702-2490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-505-6537
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34 SALEM END RD APT 19B
-----------------------------------------------------
City | FRAMINGHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01702-2490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-505-6537
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 14840
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------