Individual
CARLY ROUSSEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
576 STATE ST, SPRINGFIELD, MA 01109-4104
(413) 781-6485
Mailing address
167 MANDALAY RD, CHICOPEE, MA 01020-3925
(413) 237-8519
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1508908229
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
09/04/2020
Last updated
09/04/2020
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