Provider Demographics
NPI:1598337024
Name:DIEDHIOU, SAMUEL (MED)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:DIEDHIOU
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 HAMILTON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-2177
Mailing Address - Country:US
Mailing Address - Phone:617-490-1170
Mailing Address - Fax:
Practice Address - Street 1:349 BROADWAY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1715
Practice Address - Country:US
Practice Address - Phone:617-661-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health