Provider Demographics
NPI:1386772440
Name:DEBIASE, MARY ELLEN IRENE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY ELLEN
Middle Name:IRENE
Last Name:DEBIASE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 S MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2345
Mailing Address - Country:US
Mailing Address - Phone:978-356-0027
Mailing Address - Fax:
Practice Address - Street 1:4 S MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-2345
Practice Address - Country:US
Practice Address - Phone:978-356-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6485103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical