Provider Demographics
NPI:1821012774
Name:DEAN, MARK R (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:DEAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01061-0848
Mailing Address - Country:US
Mailing Address - Phone:413-587-7949
Mailing Address - Fax:413-586-8299
Practice Address - Street 1:90 CONZ ST
Practice Address - Street 2:SUITE 220
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3881
Practice Address - Country:US
Practice Address - Phone:413-487-7949
Practice Address - Fax:413-586-8299
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA6085103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0527076Medicaid
MA0527076Medicaid