Provider Demographics
NPI:1245745678
Name:O'DOHERTY-POPP, CARMEL BURKE (LICSW)
Entity Type:Individual
Prefix:
First Name:CARMEL
Middle Name:BURKE
Last Name:O'DOHERTY-POPP
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:781-534-7100
Mailing Address - Fax:781-534-7358
Practice Address - Street 1:300 LINDEN PONDS WAY
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3791
Practice Address - Country:US
Practice Address - Phone:781-534-7100
Practice Address - Fax:781-534-7358
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1170811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical