Provider Demographics
NPI:1114316296
Name:WRIGHT, DEBRINA
Entity Type:Individual
Prefix:
First Name:DEBRINA
Middle Name:
Last Name:WRIGHT
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:PO BOX 990993
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02199-0993
Mailing Address - Country:US
Mailing Address - Phone:617-717-9551
Mailing Address - Fax:
Practice Address - Street 1:30 NEWBURY ST
Practice Address - Street 2:3RD FLR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3236
Practice Address - Country:US
Practice Address - Phone:617-717-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14048934174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator