Individual
NICHOLE MARIE PHELPS LATENDRESSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A
Contact information
Practice address
328 MAIN ST, SOUTHBRIDGE, MA 01550-3794
(508) 765-9101
Mailing address
328 MAIN ST, SOUTHBRIDGE, MA 01550-3794
(401) 338-5096
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6400144
UNITED
RI
Enumeration date
04/09/2010
Last updated
05/10/2016
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