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DR. DIANA HEARST IKEDA PH.D.

Behavioral Health & Social Service Providers Counselor Addiction (Substance Use Disorder)

Provider NPI: 1124146717

Provider Information:
DR. DIANA  HEARST IKEDA PH.D.
Gender: F
Sole Proprietor

Practice Location:
20 TREMONT ST SUITE 12 A DUXBURY, MA 02332-5310 US
Tel: 781-934-6390  Fax: 781-934-9991

Business Mailing Address:
PO BOX 2628  DUXBURY, MA 02331-2628 US
Tel: 781-934-6390  Fax: 781-934-9991

NPI Information:
NPI: 1124146717
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
MA6917
N101YM0800XBehavioral Health & Social Service Providers
Counselor
MA6917
N103T00000XBehavioral Health & Social Service Providers
Psychologist
MA6917
N103TA0400XBehavioral Health & Social Service Providers
Psychologist
MA6917
N103TA0700XBehavioral Health & Social Service Providers
Psychologist
MA6917
Y103TB0200XBehavioral Health & Social Service Providers
Psychologist
MA6917
N103TC0700XBehavioral Health & Social Service Providers
Psychologist
MA6917
N103TC1900XBehavioral Health & Social Service Providers
Psychologist
MA6917
N103TC2200XBehavioral Health & Social Service Providers
Psychologist
MA6917
N103TF0000XBehavioral Health & Social Service Providers
Psychologist
MA6917

Other Provider Identifiers:

IssuerNumberStateType
BLUE CROSS BLUE SHIELDW05611MA01
W05211MA05
TUFTS BEHAVIORAL HEALTH407109MA01



American Medical Association 2012 taxonomy code information

Code: 103TB0200X

Type:

Classification:



Definition:



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