Provider Demographics
NPI:1023041894
Name:RONELL, DIANA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:M
Last Name:RONELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 397008
Mailing Address - Street 2:MIT BRANCH
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-7008
Mailing Address - Country:US
Mailing Address - Phone:617-491-1296
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:366 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-6733
Practice Address - Country:US
Practice Address - Phone:617-491-1296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6913103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist