Provider Demographics
NPI:1609952944
Name:DORAN, MICHAEL J (LICSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DORAN
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 1:1040 GREAT PLAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2565
Mailing Address - Country:US
Mailing Address - Phone:781-449-3500
Mailing Address - Fax:781-449-3134
Practice Address - Street 1:992 GREAT PLAIN AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492
Practice Address - Country:US
Practice Address - Phone:781-449-3500
Practice Address - Fax:781-449-3134
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2191041C0700X
MA1038031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA731452OtherTUFTS
MA731452OtherTUFTS
P02096Medicare UPIN