Provider Demographics
NPI:1003044546
Name:DIBONA, CLARENE MAE (NCTMB)
Entity Type:Individual
Prefix:MRS
First Name:CLARENE
Middle Name:MAE
Last Name:DIBONA
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-1709
Mailing Address - Country:US
Mailing Address - Phone:781-331-1615
Mailing Address - Fax:781-331-0392
Practice Address - Street 1:723 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-1709
Practice Address - Country:US
Practice Address - Phone:781-331-1615
Practice Address - Fax:781-331-0392
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA167172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist