Provider Demographics
NPI:1609021328
Name:MONTPETIT, GRACAN MARGUERITE
Entity type:Individual
Prefix:
First Name:GRACAN
Middle Name:MARGUERITE
Last Name:MONTPETIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACAN
Other - Middle Name:MARGUERITE
Other - Last Name:LEMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6 MAGNAVISTA DR
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-2293
Mailing Address - Country:US
Mailing Address - Phone:540-797-9333
Mailing Address - Fax:
Practice Address - Street 1:6 MAGNAVISTA DR
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-2293
Practice Address - Country:US
Practice Address - Phone:540-797-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2015-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA7997101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health