Provider Demographics
NPI:1437381019
Name:MUDGAL, DIPTI (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIPTI
Middle Name:
Last Name:MUDGAL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 EAMES WAY
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-6325
Mailing Address - Country:US
Mailing Address - Phone:601-310-5856
Mailing Address - Fax:
Practice Address - Street 1:596 SUMMER ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302
Practice Address - Country:US
Practice Address - Phone:508-588-8800
Practice Address - Fax:508-588-4188
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-5080103K00000X
MA8942103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst