MEDICARE: DR. DIANA M RONELL PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6913	MA

General Provider Information

NPI Number	:	1023041894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA M RONELL PHD

Provider Business Mailing Address
First Line	:	PO BOX 397008
Second Line	:	MIT BRANCH
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-7008
Country	:	US
Telephone Number	:	617-491-1296
Fax Number	:	617-726-2894

Provider Business Practice Location Address
First Line	:	366 MASSACHUSETTS AVE
Second Line	:	SUITE 101
City	:	ARLINGTON
State	:	MA
Zip	:	02474-6733
Country	:	US
Telephone Number	:	617-491-1296
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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