Provider Demographics
NPI:1588206668
Name:DE VAUGHN, ADRIENNE P (LSW, LMHC)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:P
Last Name:DE VAUGHN
Suffix:
Gender:F
Credentials:LSW, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 MCBRIDE ST.
Mailing Address - Street 2:STUDENT DEVELOPMENT
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:144 MCBRIDE ST.
Practice Address - Street 2:THE ENGLISH HIGH SCHOOL
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4013
Practice Address - Country:US
Practice Address - Phone:617-637-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA411529101YS0200X
MA313335104100000X
MA7136101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker