Provider Demographics
NPI:1730713777
Name:MCINTYRE DAOULAS, LEE A
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:A
Last Name:MCINTYRE DAOULAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 HELEN DR
Mailing Address - Street 2:
Mailing Address - City:HANSON
Mailing Address - State:MA
Mailing Address - Zip Code:02341-1207
Mailing Address - Country:US
Mailing Address - Phone:781-924-1408
Mailing Address - Fax:
Practice Address - Street 1:116 HELEN DR
Practice Address - Street 2:
Practice Address - City:HANSON
Practice Address - State:MA
Practice Address - Zip Code:02341-1207
Practice Address - Country:US
Practice Address - Phone:617-818-4923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2973103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1-19-34445OtherBCBA