Basic Information
Provider Information | |||||||||
NPI: | 1679859193 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DEPINA | ||||||||
FirstName: | WILLIAM | ||||||||
MiddleName: | M. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | B.S. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 145 FAUNCE CORNER RD STE K | ||||||||
Address2: |   | ||||||||
City: | N DARTMOUTH | ||||||||
State: | MA | ||||||||
PostalCode: | 027471263 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7742061125 | ||||||||
FaxNumber: | 7746289657 | ||||||||
Practice Location | |||||||||
Address1: | 64 INDUSTRIAL PARK RD | ||||||||
Address2: |   | ||||||||
City: | PLYMOUTH | ||||||||
State: | MA | ||||||||
PostalCode: | 023604881 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6178471950 | ||||||||
FaxNumber: | 6177741490 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/28/2011 | ||||||||
LastUpdateDate: | 07/26/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X |   |   | Y |   | Other Service Providers | Case Manager/Care Coordinator |   |
No ID Information.