Provider Demographics
NPI:1356471312
Name:MASSIMO, DORYAM CECILIA (MA)
Entity Type:Individual
Prefix:
First Name:DORYAM
Middle Name:CECILIA
Last Name:MASSIMO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SACRAMENTO STREET
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138
Mailing Address - Country:US
Mailing Address - Phone:617-354-2275
Mailing Address - Fax:617-547-4356
Practice Address - Street 1:5 SACRAMENTO STREET
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-354-2275
Practice Address - Fax:617-547-4356
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional