Provider Demographics
NPI:1689760407
Name:MORI, DEANNA LOUISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:LOUISE
Last Name:MORI
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:150 S HUNTINGTON AVE
Mailing Address - Street 2:VA BOSTON HEALTHCARE SYSTEM
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:857-364-4121
Mailing Address - Fax:857-364-4408
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:VA BOSTON HEALTHCARE SYSTEM
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:857-364-4121
Practice Address - Fax:857-364-4408
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2015-05-22
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Provider Licenses
StateLicense IDTaxonomies
MA4865103TC0700X, 261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical