Provider Demographics
NPI:1366887911
Name:DOOLEY, KATHERINE MARIE (LIC AC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 WYMAN ST
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1516
Mailing Address - Country:US
Mailing Address - Phone:617-965-4055
Mailing Address - Fax:617-965-4255
Practice Address - Street 1:87 WYMAN ST
Practice Address - Street 2:
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-1516
Practice Address - Country:US
Practice Address - Phone:617-965-4055
Practice Address - Fax:617-965-4255
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist