Healthcare Provider Details

I. General information

NPI: 1487384103
Provider Name (Legal Business Name): ANGELA MARY MION PHD, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

10 SUMMER ST APT 308
MALDEN MA
02148-3927
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-6010
  • Fax:
Mailing address:
  • Phone: 219-730-9167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberCO.00014727
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY10000286
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: