Provider Demographics
NPI:1134765928
Name:MACY, DINAH JOY
Entity type:Individual
Prefix:
First Name:DINAH
Middle Name:JOY
Last Name:MACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PORTSMOUTH ST # 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1424
Mailing Address - Country:US
Mailing Address - Phone:845-729-2988
Mailing Address - Fax:
Practice Address - Street 1:25 PORTSMOUTH ST # 1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1424
Practice Address - Country:US
Practice Address - Phone:845-729-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician