Healthcare Provider Details

I. General information

NPI: 1811132723
Provider Name (Legal Business Name): SHARON DOLIBER BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MARKET SQ
LYNN MA
01905-2420
US

IV. Provider business mailing address

269 UNION ST
LYNN MA
01901-1314
US

V. Phone/Fax

Practice location:
  • Phone: 781-596-3500
  • Fax: 781-596-3201
Mailing address:
  • Phone: 781-596-3500
  • Fax: 781-596-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number301593
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: