Provider Demographics
NPI:1083017339
Name:BABINE, DAVID J (M ED)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:BABINE
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3564
Mailing Address - Country:US
Mailing Address - Phone:413-739-1611
Mailing Address - Fax:413-739-1711
Practice Address - Street 1:80 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3564
Practice Address - Country:US
Practice Address - Phone:413-739-1611
Practice Address - Fax:413-739-1711
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool