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General NPI Number Information
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NPI Number | 1285246959
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Entity Type | Organization
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Legal Business Name | MY SELF OATH, INC
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Dates
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Enumeration Date | 08/23/2020
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Last Update Date | 08/23/2020
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Provider Practice Location Address
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Address Line | 33 DOVER ST STE 317
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City | BROCKTON
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State | MA
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Zip | 02301-5973
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Country | US
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Telephone | 508-521-9044
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Fax |
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Provider Business Mailing Address
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Address Line | 80 OLD STONE WAY APT 103
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City | WEYMOUTH
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State | MA
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Zip | 02189-2537
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Country | US
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Telephone | 617-512-0001
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | MISS YLEIS ASHLEY ENGERMAN
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Credential | LADCI, LMHC
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Telephone | 508-521-9044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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