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NPI Code Detail

MEDICARE: MIMI B DOHAN LICSW

MEDICARE: MIMI B DOHAN LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker100078MA

General Provider Information

NPI Number : 1255390316
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIMI B DOHAN LICSW
Provider Business Mailing Address
First Line : 9 BERWICK RD
Second Line :
City : LEXINGTON
State : MA
Zip : 02420-3506
Country : US
Telephone Number : 781-861-8747
Fax Number : 781-674-2004
Provider Business Practice Location Address
First Line : 9 BERWICK RD
Second Line :
City : LEXINGTON
State : MA
Zip : 02420-3506
Country : US
Telephone Number : 781-861-8747
Fax Number : 781-674-2004
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2006
Last Update Date : 07/08/2007

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