Healthcare Provider Details

I. General information

NPI: 1417873415
Provider Name (Legal Business Name): VIVIAN DOLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 HIGHLAND AVE
NEEDHAM MA
02494-3036
US

IV. Provider business mailing address

237 HIGHLAND AVE
NEEDHAM MA
02494-3036
US

V. Phone/Fax

Practice location:
  • Phone: 781-223-1691
  • Fax: 781-559-3192
Mailing address:
  • Phone: 781-223-1691
  • Fax: 781-559-3192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: