Healthcare Provider Details

I. General information

NPI: 1649472754
Provider Name (Legal Business Name): DEERFIELD ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BOYDEN LANE
DEERFIELD MA
01342
US

IV. Provider business mailing address

7 BOYDEN LANE
DEERFIELD MA
01342
US

V. Phone/Fax

Practice location:
  • Phone: 413-863-2435
  • Fax: 413-772-1118
Mailing address:
  • Phone: 413-863-2435
  • Fax: 413-772-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number2175
License Number StateMA

VIII. Authorized Official

Name: MS. SUSAN JEAN LASCALA
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: NP
Phone: 413-774-1600