Provider Demographics
NPI:1538320049
Name:DOOLEY, DOUGLAS E (LICSW)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:E
Last Name:DOOLEY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7493 147TH ST W
Mailing Address - Street 2:SUITE 107
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4505
Mailing Address - Country:US
Mailing Address - Phone:952-432-0043
Mailing Address - Fax:
Practice Address - Street 1:7493 147TH ST W
Practice Address - Street 2:SUITE 107
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4505
Practice Address - Country:US
Practice Address - Phone:952-432-0043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN707699100Medicaid
MN800003210Medicare PIN