Healthcare Provider Details

I. General information

NPI: 1720504616
Provider Name (Legal Business Name): CASSIDY G DOGGETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S BEDFORD ST STE 101W
BURLINGTON MA
01803-5152
US

IV. Provider business mailing address

67 S BEDFORD ST STE 101W
BURLINGTON MA
01803-5152
US

V. Phone/Fax

Practice location:
  • Phone: 617-942-6946
  • Fax:
Mailing address:
  • Phone: 617-942-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3826
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: