Healthcare Provider Details

I. General information

NPI: 1902867344
Provider Name (Legal Business Name): DR. DIANNE DOYLE-PITA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MILL ST SUITE 004
ARLINGTON MA
02476-4784
US

IV. Provider business mailing address

22 MILL ST SUITE 004
ARLINGTON MA
02476-4784
US

V. Phone/Fax

Practice location:
  • Phone: 781-646-0500
  • Fax: 781-646-7130
Mailing address:
  • Phone: 781-646-0500
  • Fax: 781-646-7130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4465
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: