Healthcare Provider Details

I. General information

NPI: 1104047927
Provider Name (Legal Business Name): JOANNE DOLLER WOJCIK PHD, APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BEACON ST
BROOKLINE MA
02446-5587
US

IV. Provider business mailing address

21 FIFIELD ST
WATERTOWN MA
02472
US

V. Phone/Fax

Practice location:
  • Phone: 617-962-3698
  • Fax: 617-926-0780
Mailing address:
  • Phone: 617-926-0780
  • Fax: 617-926-0780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number126652
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: