Healthcare Provider Details

I. General information

NPI: 1376369793
Provider Name (Legal Business Name): DARIA V CASAZZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 OAK ST STE G20
NEWTON MA
02464-1492
US

IV. Provider business mailing address

41 CRESTWOOD CIR
SALEM NH
03079-4101
US

V. Phone/Fax

Practice location:
  • Phone: 617-658-5611
  • Fax:
Mailing address:
  • Phone: 603-475-0453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberNHL17790395
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: