Healthcare Provider Details

I. General information

NPI: 1104754357
Provider Name (Legal Business Name): JOHN DALTON O'HAIRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MAIN ST APT 2
QUINCY MA
02169-6922
US

IV. Provider business mailing address

24 MAIN ST APT 2
QUINCY MA
02169-6922
US

V. Phone/Fax

Practice location:
  • Phone: 774-269-8140
  • Fax:
Mailing address:
  • Phone: 774-269-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: