Provider Demographics
NPI:1487089280
Name:DOETSCH, IDA M (BS)
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:M
Last Name:DOETSCH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 IRENE CT
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019-1710
Mailing Address - Country:US
Mailing Address - Phone:508-808-4894
Mailing Address - Fax:508-628-7302
Practice Address - Street 1:12 IRENE CT
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019-1710
Practice Address - Country:US
Practice Address - Phone:508-808-4894
Practice Address - Fax:508-628-7302
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health