Individual
MISS NICOLE M STAITI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.A.
Contact information
Practice address
455 SOUTH ST, BARRE, MA 01005-8909
(978) 355-4541
Mailing address
455 SOUTH ST, BARRE, MA 01005-8909
(978) 355-4541
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
1475136
MA
Other
Enumeration date
07/12/2010
Last updated
04/05/2016
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