Provider Demographics
NPI:1083105621
Name:DIBONA, DARLENE THERESE
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:THERESE
Last Name:DIBONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 HARVARD ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7999
Mailing Address - Country:US
Mailing Address - Phone:617-383-5496
Mailing Address - Fax:
Practice Address - Street 1:68 HARVARD ST STE 4
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7999
Practice Address - Country:US
Practice Address - Phone:617-383-5496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MABHP-2018-0054246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical