| Doctor Name: | DR. DIANA HEARST IKEDA |
| NPI Number: | 1124146717 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 6917 |
| Business Practice Address: | 20 Tremont St Suite 12 A Duxbury, MA - 023325310 |
| Business Phone Number: | 7819346390 |
| Business Fax Number: | 7819349991 |
| Mailing Address: | Po Box 2628, DUXBURY |
| State: | MA |
| Postal Code: | 023312628 |
| Phone Number: | 7819346390 |
| Fax Number: | 7819349991 |
| NPI Enumeration Date: | 03/26/2007 |
| NPI Last Update Date: | 12/13/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 6917 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |