Provider Demographics
NPI:1952412348
Name:DOCKTOR, NANCY A (RN,MS,CS)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:A
Last Name:DOCKTOR
Suffix:
Gender:F
Credentials:RN,MS,CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-1356
Mailing Address - Country:US
Mailing Address - Phone:781-944-8429
Mailing Address - Fax:
Practice Address - Street 1:85 CONSTITUTION LN
Practice Address - Street 2:SUITE 3C
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3694
Practice Address - Country:US
Practice Address - Phone:978-777-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153462101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0701Medicare ID - Type UnspecifiedMEDICARE B
MAP11601Medicare UPIN