Provider Demographics
NPI:1447093737
Name:MAILLOUX, ANTOINETTE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:MAILLOUX
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:MA
Mailing Address - Zip Code:01005-0021
Mailing Address - Country:US
Mailing Address - Phone:978-285-9187
Mailing Address - Fax:508-213-3982
Practice Address - Street 1:7 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:MA
Practice Address - Zip Code:01005-8726
Practice Address - Country:US
Practice Address - Phone:978-285-9187
Practice Address - Fax:508-213-3982
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2294727363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health