Healthcare Provider Details

I. General information

NPI: 1972564862
Provider Name (Legal Business Name): DOROTHY KATHERINE OHALLORAN MSW LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DOT OHALLORAN MSW LICSW

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23A WHITES PATH
S YARMOUTH MA
02664-1211
US

IV. Provider business mailing address

PO BOX 1116
DENNIS MA
02638-6116
US

V. Phone/Fax

Practice location:
  • Phone: 508-540-9292
  • Fax:
Mailing address:
  • Phone: 508-540-9292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberSW104907
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW104907
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: