Individual
DR. BRIAN M. DENIETOLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
305 BELMONT ST, UMASS ADOLESCENT CONTINUING CARE UNIT, WORCESTER, MA 01604-1681
(508) 368-3756
Mailing address
411 VILLAGE ST, MILLIS, MA 02054-1736
(508) 843-5009
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
9444
MA
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
9444
MA
Other
Enumeration date
11/19/2011
Last updated
11/19/2011
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