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NPI Code Detail

MEDICARE: MS. KATHLEEN MARY DOLLARD M.A

MEDICARE: MS. KATHLEEN MARY DOLLARD 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1538378146
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHLEEN MARY DOLLARD M.A
Provider Business Mailing Address
First Line : 9 GLENDALE AVE
Second Line :
City : SOMERVILLE
State : MA
Zip : 02144-2410
Country : US
Telephone Number : 978-744-7905
Fax Number :
Provider Business Practice Location Address
First Line : 112 BOSTON ST
Second Line :
City : SALEM
State : MA
Zip : 01970-1402
Country : US
Telephone Number : 978-744-7905
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 07/08/2007

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