Provider Demographics
NPI:1396924007
Name:ATALLAH-GUTIERREZ, DEVIN GEORGE (MA)
Entity type:Individual
Prefix:MR
First Name:DEVIN
Middle Name:GEORGE
Last Name:ATALLAH-GUTIERREZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:DEVIN
Other - Middle Name:GEORGE
Other - Last Name:ATALLAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-2769
Mailing Address - Country:US
Mailing Address - Phone:617-989-2610
Mailing Address - Fax:
Practice Address - Street 1:520 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-2769
Practice Address - Country:US
Practice Address - Phone:617-989-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health