MEDICARE: DR. ANDREW JOHN DOLE PSYD

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
1	103T00000X	Psychologist	10264	MA

General Provider Information

NPI Number	:	1275038424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW JOHN DOLE PSYD

Provider Business Mailing Address
First Line	:	175 FOREST STREET
Second Line	:	COUNSELING CENTER
City	:	WALTHAM
State	:	MA
Zip	:	02452
Country	:	US
Telephone Number	:	781-891-2265
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 FOREST STREET
Second Line	:	COUNSELING CENTER
City	:	WALTHAM
State	:	MA
Zip	:	02452-0245
Country	:	US
Telephone Number	:	781-891-2265
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	03/29/2018

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