Healthcare Provider Details

I. General information

NPI: 1205992336
Provider Name (Legal Business Name): DIANE T RIOPELLE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ANDRESKI DR
FREMONT NH
03044-3020
US

IV. Provider business mailing address

24 ANDRESKI DR
FREMONT NH
03044-3020
US

V. Phone/Fax

Practice location:
  • Phone: 978-590-9367
  • Fax: 978-372-6173
Mailing address:
  • Phone: 978-590-9367
  • Fax: 978-372-6173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110726
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: