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General NPI Number Information
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NPI Number | 1619053915
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Entity Type | Individual
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Provider Name | MANOBALDO MARCOS AMARAL PSYCHOLOGIST
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Gender | Male
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Dates
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Enumeration Date | 10/29/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 390 MASSACHUSETTS AVE
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City | ARLINGTON
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State | MA
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Zip | 02474-6799
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Country | US
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Telephone | 857-472-4512
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Fax |
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Provider Business Mailing Address
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Address Line | 111 KITTREDGE ST
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City | ROSLINDALE
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State | MA
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Zip | 02131-3504
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Country | US
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Telephone | 617-327-8783
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 7884
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License Number State | MA
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