Provider Demographics
NPI:1861147019
Name:BOUFFIOU, ANGELIQUE MARIE
Entity type:Individual
Prefix:MS
First Name:ANGELIQUE
Middle Name:MARIE
Last Name:BOUFFIOU
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANGELIQUE
Other - Middle Name:ANASTASIA
Other - Last Name:BEAUCHENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 WESTINGHOUSE PLZ FL 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2075
Mailing Address - Country:US
Mailing Address - Phone:617-910-9605
Mailing Address - Fax:617-910-9784
Practice Address - Street 1:1 WESTINGHOUSE PLZ FL 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02136-2075
Practice Address - Country:US
Practice Address - Phone:617-904-9605
Practice Address - Fax:617-910-9784
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)