MEDICARE: DOUGLAS RYAN KLIER M.A.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1356659155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS RYAN KLIER M.A.

Provider Business Mailing Address
First Line	:	44 FRONT ST STE 490
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01608-1742
Country	:	US
Telephone Number	:	508-799-2934
Fax Number	:	508-770-1974

Provider Business Practice Location Address
First Line	:	44 FRONT ST STE 490
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01608-1742
Country	:	US
Telephone Number	:	508-799-2934
Fax Number	:	508-770-1974

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

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	09/15/2010

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