Doctor Name: | MR. MICHAEL RAYMOND DEVINE |
NPI Number: | 1427172535 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.ED, LMHC |
License Number: | 916 |
Business Practice Address: | 30 Ripley St Wilbraham, MA - 010952233 |
Business Phone Number: | 4133131074 |
Business Fax Number: | 4135994991 |
Mailing Address: | 30 Ripley St, WILBRAHAM |
State: | MA |
Postal Code: | 010952233 |
Phone Number: | 4133131074 |
Fax Number: | 4135994991 |
NPI Enumeration Date: | 03/16/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 916 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |