Individual
STACY A GONSALVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
126 COVE ST, FALL RIVER, MA 02720-1306
(508) 678-0041
Mailing address
15 CRANBERRY LN, BERKLEY, MA 02779-1349
(508) 951-7479
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1312677
—
MA
01
—
685661
TUFTS
MA
Enumeration date
06/30/2009
Last updated
10/06/2016
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