Provider Demographics
NPI:1568538171
Name:ANDERSON, DOROTHY L (LICSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:L
Other - Last Name:ANDERSON-PERALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:27 NOTRE DAME RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-2032
Mailing Address - Country:US
Mailing Address - Phone:781-275-1682
Mailing Address - Fax:
Practice Address - Street 1:64 CHURCH ST
Practice Address - Street 2:LL
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3730
Practice Address - Country:US
Practice Address - Phone:617-441-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1131591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical