1437618832 NPI number — CHERIE RENEE BRISEBOIS-TETRAULT RE LE CLT LLT

Table of content: CHERIE RENEE BRISEBOIS-TETRAULT RE LE CLT LLT (NPI 1437618832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437618832 NPI number — CHERIE RENEE BRISEBOIS-TETRAULT RE LE CLT LLT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRISEBOIS-TETRAULT
Provider First Name:
CHERIE
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RE LE CLT LLT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437618832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
460 GRANBY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH HADLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01075-2145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-733-2499
Provider Business Mailing Address Fax Number:
413-255-0443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 GRANBY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH HADLEY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01075-2145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-733-2499
Provider Business Practice Location Address Fax Number:
413-255-0443
Provider Enumeration Date:
03/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246Z00000X , with the licence number:  1702 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 246Z00000X , with the licence number: L-30 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246Z00000X , with the licence number: 547 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1702 . This is a "ELECTROLOGIST LICENSE NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 547 . This is a "ELECTROLOGIST LICENSE NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: L-30 . This is a "LASER ELECTROLYSIS LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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