MEDICARE: DEJOUR WASHINGTON

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1508723248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEJOUR WASHINGTON

Provider Business Mailing Address
First Line	:	1234 HYDE PARK AVE
Second Line	:
City	:	HYDE PARK
State	:	MA
Zip	:	02136-2819
Country	:	US
Telephone Number	:	888-763-7272
Fax Number	:	877-243-2959

Provider Business Practice Location Address
First Line	:	1234 HYDE PARK AVE
Second Line	:
City	:	HYDE PARK
State	:	MA
Zip	:	02136-2819
Country	:	US
Telephone Number	:	888-763-7272
Fax Number	:	877-243-2959

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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Directions to “ DEJOUR WASHINGTON ” Practice Location

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