Provider Demographics
NPI:1073817573
Name:DEPINA, DANIEL MENDES (MED LADC I, MA PG)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MENDES
Last Name:DEPINA
Suffix:
Gender:M
Credentials:MED LADC I, MA PG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 NORTH MAIN STREET
Mailing Address - Street 2:APT. 308
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3626
Mailing Address - Country:US
Mailing Address - Phone:508-857-9058
Mailing Address - Fax:
Practice Address - Street 1:682 NORTH MAIN STREET
Practice Address - Street 2:APT. 308
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3626
Practice Address - Country:US
Practice Address - Phone:508-857-9058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)