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NPI Code Detail

MEDICARE: MIA PRUETT PH.D.

MEDICARE: MIA PRUETT PH.D.
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
1103TC1900XCounseling Psychologist2491MA

General Provider Information

NPI Number : 1982678520
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIA PRUETT PH.D.
Provider Business Mailing Address
First Line : 66 MAIN ST
Second Line :
City : NORTH EASTON
State : MA
Zip : 02356-1443
Country : US
Telephone Number : 508-230-5083
Fax Number : 508-230-5089
Provider Business Practice Location Address
First Line : 66 MAIN ST
Second Line :
City : NORTH EASTON
State : MA
Zip : 02356-1443
Country : US
Telephone Number : 508-230-5083
Fax Number : 508-230-5089
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2006
Last Update Date : 07/08/2007

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Directions to “ MIA PRUETT PH.D.” Practice Location

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