Healthcare Provider Details

I. General information

NPI: 1760710099
Provider Name (Legal Business Name): DR. WILLIAM DEFRANC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 COPELAND ST SUITE 320
QUINCY MA
02169-4005
US

IV. Provider business mailing address

234 COPELAND ST SUITE 320
QUINCY MA
02169-4005
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-0137
  • Fax:
Mailing address:
  • Phone: 617-789-0137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7806
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: