Provider Demographics
NPI:1912442526
Name:DIBRIELLE, DOUG (LMHC)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:DIBRIELLE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:DOUG
Other - Middle Name:
Other - Last Name:DIBRIELLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:39 READING HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-1933
Mailing Address - Country:US
Mailing Address - Phone:617-429-6838
Mailing Address - Fax:855-532-9720
Practice Address - Street 1:185 DEVONSHIRE ST STE 500
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-1407
Practice Address - Country:US
Practice Address - Phone:617-429-6838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8027101Y00000X, 101YP2500X, 101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)