Healthcare Provider Details

I. General information

NPI: 1710023890
Provider Name (Legal Business Name): DARCEY L SURETTE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 BROADWAY
SOMERVILLE MA
02144-1703
US

IV. Provider business mailing address

65 TYLER AVE
MEDFORD MA
02155-2111
US

V. Phone/Fax

Practice location:
  • Phone: 617-821-9996
  • Fax:
Mailing address:
  • Phone: 617-821-9996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1268
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: