Provider Demographics
NPI:1598018566
Name:STAELENS, NANCY ALICE (MED)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ALICE
Last Name:STAELENS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:GILL
Mailing Address - State:MA
Mailing Address - Zip Code:01354-9716
Mailing Address - Country:US
Mailing Address - Phone:413-863-5173
Mailing Address - Fax:413-863-2175
Practice Address - Street 1:246 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:GILL
Practice Address - State:MA
Practice Address - Zip Code:01354-9716
Practice Address - Country:US
Practice Address - Phone:413-863-5173
Practice Address - Fax:413-863-2175
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor