Healthcare Provider Details

I. General information

NPI: 1942257274
Provider Name (Legal Business Name): ELIZABETH DEMEDEIROS-DUCHARME PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 03/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N 2ND ST
NEW BEDFORD MA
02740-6249
US

IV. Provider business mailing address

50 N 2ND ST
NEW BEDFORD MA
02740-6249
US

V. Phone/Fax

Practice location:
  • Phone: 508-993-1377
  • Fax: 508-999-7795
Mailing address:
  • Phone: 508-993-1377
  • Fax: 508-999-7795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8039
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: