Provider Demographics
NPI:1437374477
Name:DUVELSON-CHRYSOSTOME, PAULA MARIE (PHD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:MARIE
Last Name:DUVELSON-CHRYSOSTOME
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 N MAIN ST
Mailing Address - Street 2:SUITES 3B & 8
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4170
Mailing Address - Country:US
Mailing Address - Phone:781-413-5923
Mailing Address - Fax:781-986-4801
Practice Address - Street 1:324 N MAIN ST
Practice Address - Street 2:SUITES 3B & 8
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4170
Practice Address - Country:US
Practice Address - Phone:781-986-4800
Practice Address - Fax:781-986-4801
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1894641Medicaid