Doctor Name: | MS. MARIA ROSE FAIRCLOUGH |
NPI Number: | 1093016123 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S |
License Number: | |
Business Practice Address: | 20 Vesper Ln L-1 Gouin Village Nantucket, MA - 025544394 |
Business Phone Number: | 5082282689 |
Business Fax Number: | 5082283613 |
Mailing Address: | 20 Vesper Ln, L-1 Gouin Village NANTUCKET |
State: | MA |
Postal Code: | 025544394 |
Phone Number: | 5082282689 |
Fax Number: | 5082283613 |
NPI Enumeration Date: | 11/05/2010 |
NPI Last Update Date: | 11/05/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |