Individual
MS. EILEEN RYAN O'DOHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M. A., LADC I
Contact information
Practice address
20 FORSYTHE AVE, SOUTH YARMOUTH, MA 02664-1814
(508) 398-5155
(508) 398-3478
Mailing address
20 FORSYTHE AVE, SOUTH YARMOUTH, MA 02664-1814
(508) 398-5155
(508) 398-3478
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1383
LADC I
MA
Enumeration date
04/10/2007
Last updated
07/08/2007
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