Provider Demographics
NPI:1851053193
Name:PLANTE, MADISON LACEY (BH)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:LACEY
Last Name:PLANTE
Suffix:
Gender:F
Credentials:BH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ENGLISH ROW
Mailing Address - Street 2:
Mailing Address - City:SOUTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01560-1322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 ENGLISH ROW
Practice Address - Street 2:
Practice Address - City:SOUTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01560-1322
Practice Address - Country:US
Practice Address - Phone:774-275-7553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health