Healthcare Provider Details

I. General information

NPI: 1821870395
Provider Name (Legal Business Name): STACEY DOBROWOLSKI RN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TAUNTON GRN STE 5
TAUNTON MA
02780-3243
US

IV. Provider business mailing address

29 BROWNS LN
EAST BRIDGEWATER MA
02333-1162
US

V. Phone/Fax

Practice location:
  • Phone: 774-409-6892
  • Fax:
Mailing address:
  • Phone: 617-257-2945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2295423
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2295423
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: