Healthcare Provider Details

I. General information

NPI: 1073692398
Provider Name (Legal Business Name): RENEE E DEYOE MSW LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 GREAT RD BOUNDARIES THERAPY CTR
ACTON MA
01720
US

IV. Provider business mailing address

266 PEAKHAM RD
SUDBURY MA
01776
US

V. Phone/Fax

Practice location:
  • Phone: 978-263-4878
  • Fax: 978-635-0386
Mailing address:
  • Phone: 978-263-4878
  • Fax: 978-635-0386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1029948
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: