Provider Demographics
NPI:1336638246
Name:DOO, BETTY G I (EDD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:G
Last Name:DOO
Suffix:I
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CARY AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7710
Mailing Address - Country:US
Mailing Address - Phone:781-258-5156
Mailing Address - Fax:
Practice Address - Street 1:26 CARY AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7710
Practice Address - Country:US
Practice Address - Phone:781-258-5156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4982-PY-PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical