Andrea Bacon
Individual provider Active NPI Counselor · Braintree, MA
NPI 1861036428 · NPPES record last updated Nov 6, 2019
Key facts
- NPI
- 1861036428
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 400 Washington St Ste 303
Braintree, MA 02184-4768 - Phone
- (781) 843-3683
- NPI assigned
- Nov 6, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
400 Washington St Ste 303
Braintree, MA 02184-4768
Mailing address
61 Richards Rd
Southborough, MA 01772-1928
Phone (508) 330-1440
Other providers in Braintree, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.