Provider Demographics
NPI:1609898675
Name:DELISI, TONI (PSY D)
Entity type:Individual
Prefix:DR
First Name:TONI
Middle Name:
Last Name:DELISI
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PARK PLZ
Mailing Address - Street 2:SUITE 611
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-4303
Mailing Address - Country:US
Mailing Address - Phone:617-292-7792
Mailing Address - Fax:
Practice Address - Street 1:20 PARK PLZ
Practice Address - Street 2:SUITE 611
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4303
Practice Address - Country:US
Practice Address - Phone:617-292-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6475103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA44589OtherNATIONAL REGISTER