Healthcare Provider Details

I. General information

NPI: 1457669590
Provider Name (Legal Business Name): MRS. DEBORAH ANN PUCHOVSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 FORTUNE BLVD
MILFORD MA
01757-1723
US

IV. Provider business mailing address

22 CRESTVIEW DR
MENDON MA
01756-1135
US

V. Phone/Fax

Practice location:
  • Phone: 508-478-7752
  • Fax:
Mailing address:
  • Phone: 508-478-2456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: