Provider Demographics
NPI:1962927947
Name:D'ORIO, VANESSA (PHD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:D'ORIO
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 1:1368 BEACON ST STE 116
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2800
Mailing Address - Country:US
Mailing Address - Phone:617-959-1010
Mailing Address - Fax:617-734-0734
Practice Address - Street 1:1368 BEACON ST STE 116
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2800
Practice Address - Country:US
Practice Address - Phone:617-959-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10633103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist