Provider Demographics
NPI:1639201189
Name:IANNACCHIONE, DEANNE MICHELLE (M ED LADCI)
Entity Type:Individual
Prefix:MRS
First Name:DEANNE
Middle Name:MICHELLE
Last Name:IANNACCHIONE
Suffix:
Gender:F
Credentials:M ED LADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ROYAL RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1940
Mailing Address - Country:US
Mailing Address - Phone:508-757-1536
Mailing Address - Fax:
Practice Address - Street 1:95 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2431
Practice Address - Country:US
Practice Address - Phone:508-799-9000
Practice Address - Fax:508-756-0548
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1547101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)