Provider Demographics
NPI:1306330915
Name:ST HILAIRE, JOANE
Entity type:Individual
Prefix:
First Name:JOANE
Middle Name:
Last Name:ST HILAIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 MONTELLO ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-6657
Mailing Address - Country:US
Mailing Address - Phone:508-427-4383
Mailing Address - Fax:508-584-4328
Practice Address - Street 1:891 MONTELLO ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-6657
Practice Address - Country:US
Practice Address - Phone:617-909-4448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA101Y00000XMedicaid
MA101Y00000XOtherN/A