Individual
STEFANIE BOURASSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
145 HAZARD AVE, SUITE B, ENFIELD, CT 06082-4521
(860) 265-2571
(860) 265-2574
Mailing address
145 HAZARD AVE, SUITE B, ENFIELD, CT 06082-4521
(860) 265-2571
(860) 265-2574
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
008279
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51084
BIRTHDATE
CT
Enumeration date
03/07/2008
Last updated
03/07/2008
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