Provider Demographics
NPI:1912143447
Name:DEBOALT, ANNE SPENGLER (LMHC,CCMHC)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:SPENGLER
Last Name:DEBOALT
Suffix:
Gender:F
Credentials:LMHC,CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SHAKER ROAD
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451
Mailing Address - Country:US
Mailing Address - Phone:978-772-3968
Mailing Address - Fax:978-371-2597
Practice Address - Street 1:79 SHAKER ROAD
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:04151
Practice Address - Country:US
Practice Address - Phone:978-772-3968
Practice Address - Fax:978-371-2597
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA83-CC101YM0800X
MA#83LMHC101Y00000X
MA#83#32529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
32529OtherNBCC, CCMHC