Provider Demographics
NPI:1134962079
Name:DOLPHIN, CRAIG M (MSW, MPS)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:M
Last Name:DOLPHIN
Suffix:
Gender:M
Credentials:MSW, MPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-1823
Mailing Address - Country:US
Mailing Address - Phone:508-765-9167
Mailing Address - Fax:508-765-2839
Practice Address - Street 1:29 PINE ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1823
Practice Address - Country:US
Practice Address - Phone:508-765-9167
Practice Address - Fax:508-765-2839
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker