Individual
MICHENIDE AUGUSTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1115 W CHESTNUT ST, BROCKTON, MA 02301-7501
(508) 580-4691
Mailing address
215 COURT ST APT 1, BROCKTON, MA 02302-4600
(617) 682-5550
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
05/24/2013
Last updated
05/24/2013
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