Provider Demographics
NPI:1275779092
Name:LOUISE, DOROTHY (MSW)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:
Last Name:LOUISE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ADDISON STREET
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-8107
Mailing Address - Country:US
Mailing Address - Phone:781-504-8939
Mailing Address - Fax:
Practice Address - Street 1:35 ADDISON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-8107
Practice Address - Country:US
Practice Address - Phone:781-504-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10205911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical