Individual
DR. MIRIAM ANN DEFANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
131 W MAIN ST STE 27, ORANGE, MA 01364-1151
(978) 544-3330
(978) 544-1899
Mailing address
PO BOX 437, ORANGE, MA 01364-0437
(978) 544-3330
(978) 544-1899
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
6207
MA
103T00000X
Psychologist
Primary
6207
MA
103TC0700X
Clinical Psychologist
6207
MA
103TC2200X
Clinical Child & Adolescent Psychologist
6207
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0502570
—
MA
01
—
093085
VALUEOPTIONS
MA
01
—
102900
MAGELLAN BEHAVIORAL HEALT
MA
01
—
5503602
AETNA PPO
MA
01
—
726233
TUFTS HEALTH PLAN
MA
01
—
DE W04980
BLUE CROSS BLUE SHIELD
MA
Enumeration date
08/30/2006
Last updated
02/20/2010
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