Doctor Name: | MRS. DIANE MARIE MCAVOY |
NPI Number: | 1104117506 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.I.C.S.W. |
License Number: | 114780 |
Business Practice Address: | 395 Washington St Suite #8 Dedham, MA - 020264456 |
Business Phone Number: | 7813264110 |
Business Fax Number: | 5082035163 |
Mailing Address: | 395 Washington St, Suite #8 DEDHAM |
State: | MA |
Postal Code: | 020264456 |
Phone Number: | 7813264110 |
Fax Number: | 5082035163 |
NPI Enumeration Date: | 04/20/2011 |
NPI Last Update Date: | 08/18/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 114780 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |