Provider Demographics
NPI:1023301223
Name:DUBE, EMILY ANN (MS)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ANN
Last Name:DUBE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 NORMAN ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-5003
Mailing Address - Country:US
Mailing Address - Phone:413-736-8329
Mailing Address - Fax:413-746-4270
Practice Address - Street 1:107 CONWAY ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2342
Practice Address - Country:US
Practice Address - Phone:413-774-2195
Practice Address - Fax:413-774-2194
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303295Medicaid
MA1307576 (SA)Medicaid
MAY10086Medicare PIN