Provider Demographics
NPI:1285246959
Name:MY SELF OATH, INC
Entity type:Organization
Organization Name:MY SELF OATH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:YLEIS
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:ENGERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LADCI, LMHC
Authorized Official - Phone:508-521-9044
Mailing Address - Street 1:80 OLD STONE WAY APT 103
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-2537
Mailing Address - Country:US
Mailing Address - Phone:617-512-0001
Mailing Address - Fax:
Practice Address - Street 1:33 DOVER ST STE 317
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5973
Practice Address - Country:US
Practice Address - Phone:508-521-9044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty