Provider Demographics
NPI:1235437096
Name:AVERY, DAVID LEON (LMHC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEON
Last Name:AVERY
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BURT ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-3705
Mailing Address - Country:US
Mailing Address - Phone:617-282-9772
Mailing Address - Fax:617-506-1573
Practice Address - Street 1:35 BURT ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-3705
Practice Address - Country:US
Practice Address - Phone:617-282-9772
Practice Address - Fax:617-506-1573
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7173101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health