Individual
DR. DIANA HEARST IKEDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
20 TREMONT ST, SUITE 12 A, DUXBURY, MA 02332-5310
(781) 934-6390
(781) 934-9991
Mailing address
PO BOX 2628, DUXBURY, MA 02331-2628
(781) 934-6390
(781) 934-9991
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
6917
MA
101YM0800X
Mental Health Counselor
6917
MA
103T00000X
Psychologist
6917
MA
103TA0400X
Addiction (Substance Use Disorder) Psychologist
6917
MA
103TA0700X
Adult Development & Aging Psychologist
6917
MA
103TB0200X
Cognitive & Behavioral Psychologist
Primary
6917
MA
103TC0700X
Clinical Psychologist
6917
MA
103TC1900X
Counseling Psychologist
6917
MA
103TC2200X
Clinical Child & Adolescent Psychologist
6917
MA
103TF0000X
Family Psychologist
6917
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
407109
TUFTS BEHAVIORAL HEALTH
MA
05
—
W05211
—
MA
01
—
W05611
BLUE CROSS BLUE SHIELD
MA
Enumeration date
03/26/2007
Last updated
12/13/2013
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