Provider Demographics
NPI:1295544211
Name:BOISVERT, DONALD R JR (LADC II)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:R
Last Name:BOISVERT
Suffix:JR
Gender:M
Credentials:LADC II
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 ALLERTON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3754
Mailing Address - Country:US
Mailing Address - Phone:774-204-5358
Mailing Address - Fax:
Practice Address - Street 1:61 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7246
Practice Address - Country:US
Practice Address - Phone:774-204-5358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21260101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)