Provider Demographics
NPI:1184128522
Name:DENNIS, NOEL SHAWN
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:SHAWN
Last Name:DENNIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CATHARINE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2709
Mailing Address - Country:US
Mailing Address - Phone:508-755-8088
Mailing Address - Fax:508-755-1138
Practice Address - Street 1:21 CATHARINE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2709
Practice Address - Country:US
Practice Address - Phone:508-755-8088
Practice Address - Fax:508-755-1138
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)