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General NPI Number Information
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NPI Number | 1841336757
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Entity Type | Individual
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Provider Name | DALE E DILLAVOU PHD
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 545 CONCORD AVE SUITE 20
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City | CAMBRIDGE
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State | MA
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Zip | 02138
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Country | US
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Telephone | 617-499-9977
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Fax |
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Provider Business Mailing Address
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Address Line | 25 NORTH HANCOCK ST
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City | LEXINGTON
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State | MA
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Zip | 02420-3406
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Country | US
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Telephone | 781-862-2576
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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 | 3613
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License Number State | MA
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