Healthcare Provider Details

I. General information

NPI: 1801809181
Provider Name (Legal Business Name): DENNIS E TYRELL PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 CANTON AVE
MILTON MA
02186-3134
US

IV. Provider business mailing address

720 CANTON AVE
MILTON MA
02186-3134
US

V. Phone/Fax

Practice location:
  • Phone: 617-901-2201
  • Fax:
Mailing address:
  • Phone: 617-298-7165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8124
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: