Healthcare Provider Details

I. General information

NPI: 1386740157
Provider Name (Legal Business Name): MARGARET T DOLAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVE DOWLING 9
BOSTON MA
02118-4001
US

IV. Provider business mailing address

850 HARRISON AVE DOWLING 9
BOSTON MA
02118-4001
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4292
  • Fax: 617-414-4517
Mailing address:
  • Phone: 617-414-4292
  • Fax: 617-414-4517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1030867
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: