Basic Information
| Provider Information | |||||||||
| NPI: | 1083218218 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'TOOLE | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | EVELYN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 54 SEAVER ST | ||||||||
| Address2: | |||||||||
| City: | STOUGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020722637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175997999 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 354 WAVERLEY ST | ||||||||
| Address2: | |||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017027079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086612020 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2020 | ||||||||
| LastUpdateDate: | 07/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 12060-MH-CC | MA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.