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General NPI Number Information
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NPI Number | 1164662219
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Entity Type | Organization
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Legal Business Name | DIANE ROBERTS STOLER EDD, LLC
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 87 WASHINGTON ST.
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City | BOXFORD
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State | MA
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Zip | 01921-1240
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Country | US
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Telephone | 978-352-6349
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Fax | 978-352-2835
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Provider Business Mailing Address
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Address Line | P.O. BOX 148
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City | GEORGETOWN
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State | MA
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Zip | 01833-0148
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Country | US
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Telephone | 978-352-6349
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Fax | 978-352-2835
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Authorized Official
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Title or Position | CEO
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Name | DIANE R STOLER
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Credential | EDD
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Telephone | 978-352-6349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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License Number | 2229
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 2229
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 2229
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License Number State | MA
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