Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1275150138 |
---|---|
Provider Name | Nicole Doyle-Tedford |
First Address | Tewksbury, MA 01876-1950 |
Second Address | Dracut, MA 01826-5210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2020 |
Last Update Date | 27/01/2021 |