Individual ProviderMark DagnallCounselorBehavioral Health & Social Service ProvidersPractice Address75 Amory St, Rear Entrance, Boston, MA 02119-1051(857) 399-1915PECOS EnrollmentBased on the most recent information from CMS, provider Mark Dagnall is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1083930192Provider TypeIndividualFull NameDagnall, MarkTitleMr.CredentialLMHC, LADC 1, CRCGenderMaleSole ProprietorYesEnumeration Date4/14/2010Last Updated7/21/2015Contact InformationPractice LocationPractice Address75 Amory St, Rear Entrance, Boston, MA 02119-1051Phone(857) 399-1915Fax(857) 399-1901Mailing LocationMailing Address75 Amory St, Rear Entrance, Boston, MA 02119-1051Phone(857) 399-1915Fax(857) 399-1901Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense9039MassachusettsCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicense2411Massachusetts