Provider Demographics
NPI:1942343470
Name:DOLLER, KATHRYN GAIL (MSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:GAIL
Last Name:DOLLER
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 1:108 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-1248
Mailing Address - Country:US
Mailing Address - Phone:508-285-9400
Mailing Address - Fax:508-285-6573
Practice Address - Street 1:108 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-1248
Practice Address - Country:US
Practice Address - Phone:508-285-9400
Practice Address - Fax:508-285-6573
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1049521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1305565Medicaid
MAPO4817OtherBCBS PROVIDER #
MA1305565Medicaid