Basic Information
| Provider Information | |||||||||
| NPI: | 1811137086 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUBLIN | ||||||||
| FirstName: | ADDIE | ||||||||
| MiddleName: | CLARE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RNCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 CITY HALL MALL | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021554754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813065463 | ||||||||
| FaxNumber: | 7813065015 | ||||||||
| Practice Location | |||||||||
| Address1: | 26 CITY HALL MALL | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021554754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813065463 | ||||||||
| FaxNumber: | 7813065015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2009 | ||||||||
| LastUpdateDate: | 03/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | RN261103 | MA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.