Individual
HALLIE STAMENTIA DUBUISSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19 W CHESTNUT STREET, BROCKTON, MA 02301
(774) 339-9643
Mailing address
19 W CHESTNUT STREET, BROCKTON, MA 02301
(774) 339-9643
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
SA0720273
MA
Other
Enumeration date
06/17/2024
Last updated
06/27/2024
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