Healthcare Provider Details

I. General information

NPI: 1912992199
Provider Name (Legal Business Name): ALAN DIMSON-DOYLE LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 POST OFFICE SQ SUITE 2
SHARON MA
02067-1963
US

IV. Provider business mailing address

36 MECHANIC ST STE 205
FOXBORO MA
02035-2073
US

V. Phone/Fax

Practice location:
  • Phone: 781-784-3709
  • Fax:
Mailing address:
  • Phone: 781-784-3709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111882
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: