Provider Demographics
NPI:1164725396
Name:FAFARD, DIANE D
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:D
Last Name:FAFARD
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 1:385 COURT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7304
Mailing Address - Country:US
Mailing Address - Phone:508-830-3444
Mailing Address - Fax:508-830-3434
Practice Address - Street 1:385 COURT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7304
Practice Address - Country:US
Practice Address - Phone:508-830-3444
Practice Address - Fax:508-830-3434
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator