Provider Demographics
NPI:1790821411
Name:NOWELL, DAVID DEAN (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DEAN
Last Name:NOWELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 MAY ST
Mailing Address - Street 2:FAIRLAWN HOSPITAL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-4339
Mailing Address - Country:US
Mailing Address - Phone:508-471-9254
Mailing Address - Fax:508-885-8989
Practice Address - Street 1:189 MAY ST
Practice Address - Street 2:FAIRLAWN HOSPITAL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-4339
Practice Address - Country:US
Practice Address - Phone:508-471-9254
Practice Address - Fax:508-885-8989
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA7226103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1894579Medicaid
MA1894579Medicaid