Provider Demographics
NPI:1093917668
Name:DUBOIS, CATHERINE IONE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:IONE
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 EDGEMONT ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1923
Mailing Address - Country:US
Mailing Address - Phone:617-469-3861
Mailing Address - Fax:
Practice Address - Street 1:91 WYMAN ST
Practice Address - Street 2:
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-1529
Practice Address - Country:US
Practice Address - Phone:617-499-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7199103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical