Healthcare Provider Details

I. General information

NPI: 1780756791
Provider Name (Legal Business Name): THEODORA NOYES MCDOWELL LICSW, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 MAIN STREET
FLORENCE MA
01062
US

IV. Provider business mailing address

92 MAIN STREET
FLORENCE MA
01062
US

V. Phone/Fax

Practice location:
  • Phone: 413-533-5201
  • Fax: 413-532-1846
Mailing address:
  • Phone: 617-877-7726
  • Fax: 978-225-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number104545
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104545
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: