Healthcare Provider Details

I. General information

NPI: 1609700749
Provider Name (Legal Business Name): ANNGENE ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SURFSIDE AVE
WINTHROP MA
02152-2537
US

IV. Provider business mailing address

111 BEDFORD DR NE
PORT CHARLOTTE FL
33952-8106
US

V. Phone/Fax

Practice location:
  • Phone: 941-457-2380
  • Fax:
Mailing address:
  • Phone: 978-821-8160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN M MACDOUGALL
Title or Position: CLINICIAN
Credential: LICSW
Phone: 978-821-8160