Provider Demographics
NPI:1487700175
Name:HUBBARD, DAPHNE L (EDM,LMHC)
Entity type:Individual
Prefix:MS
First Name:DAPHNE
Middle Name:L
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:EDM,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CONCORD SQ
Mailing Address - Street 2:#2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3185
Mailing Address - Country:US
Mailing Address - Phone:617-266-3464
Mailing Address - Fax:
Practice Address - Street 1:9 CONCORD SQ
Practice Address - Street 2:#2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3185
Practice Address - Country:US
Practice Address - Phone:617-266-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3172101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTXXXXX6310OtherUNITED HEALTH
MA409315OtherTUFTS HEALTH PLAN
LM0095OtherBLUE CROSS&BLUESHIELDOFMA
MA3172OtherLMHC