Healthcare Provider Details

I. General information

NPI: 1528394111
Provider Name (Legal Business Name): WILLARD M DAGGETT III M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 07/07/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MONUMENT SQ STE 200
LEOMINSTER MA
01453-5711
US

IV. Provider business mailing address

305 GOODALE ST
WEST BOYLSTON MA
01583-1011
US

V. Phone/Fax

Practice location:
  • Phone: 508-277-5158
  • Fax: 508-267-0096
Mailing address:
  • Phone: 508-835-0901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: