Individual
CHERIE RENEE BRISEBOIS-TETRAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RE LE
Contact information
Practice address
62 WESTFIELD ST STE 2, WEST SPRINGFIELD, MA 01089-2539
(413) 733-2499
(413) 255-0443
Mailing address
460 GRANBY RD, SOUTH HADLEY, MA 01075-2145
(413) 733-2499
(413) 255-0443
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
1702
MA
246Z00000X
Other Specialist/Technologist
547
CT
246Z00000X
Other Specialist/Technologist
L-30
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1702
ELECTROLOGIST LICENSE NUMBER
MA
01
—
547
ELECTROLOGIST LICENSE NUMBER
CT
01
—
L-30
LASER ELECTROLYSIS LICENSE
MA
Enumeration date
03/15/2019
Last updated
01/30/2021
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