Provider Demographics
NPI:1649472754
Name:DEERFIELD ACADEMY
Entity type:Organization
Organization Name:DEERFIELD ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LASCALA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:413-774-1600
Mailing Address - Street 1:7 BOYDEN LANE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01342
Mailing Address - Country:US
Mailing Address - Phone:413-863-2435
Mailing Address - Fax:413-772-1118
Practice Address - Street 1:7 BOYDEN LANE
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01342
Practice Address - Country:US
Practice Address - Phone:413-863-2435
Practice Address - Fax:413-772-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2175261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health