Healthcare Provider Details

I. General information

NPI: 1902882731
Provider Name (Legal Business Name): DOUGLAS M. DEVILLE PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 BOYLSTON ST 4TH FLOOR
BOSTON MA
02116-2639
US

IV. Provider business mailing address

729 BOYLSTON ST 4TH FLOOR
BOSTON MA
02116-2639
US

V. Phone/Fax

Practice location:
  • Phone: 617-262-7771
  • Fax: 617-262-7790
Mailing address:
  • Phone: 617-262-7771
  • Fax: 617-262-7790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6011
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number600
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: