Provider Demographics
NPI:1720258932
Name:DIVER, TANYA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:DIVER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY, FEGAN 8
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-7637
Mailing Address - Fax:617-730-0319
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY, FEGAN 8
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-7637
Practice Address - Fax:617-730-0319
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA8823103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist