Provider Demographics
NPI:1972564862
Name:OHALLORAN, DOROTHY KATHERINE (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:KATHERINE
Last Name:OHALLORAN
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:DOT
Other - Middle Name:
Other - Last Name:OHALLORAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW LICSW
Mailing Address - Street 1:PO BOX 1116
Mailing Address - Street 2:
Mailing Address - City:DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02638-6116
Mailing Address - Country:US
Mailing Address - Phone:508-540-9292
Mailing Address - Fax:
Practice Address - Street 1:23A WHITES PATH
Practice Address - Street 2:
Practice Address - City:S YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-1211
Practice Address - Country:US
Practice Address - Phone:508-540-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW104907103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04460Medicare ID - Type Unspecified