Provider Demographics
NPI:1003387432
Name:DORZEK, JESSICA AMBROSE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:AMBROSE
Last Name:DORZEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 STONE COTTAGE LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-7462
Mailing Address - Country:US
Mailing Address - Phone:914-720-3498
Mailing Address - Fax:
Practice Address - Street 1:9555 LEBANON RD STE 602
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6084
Practice Address - Country:US
Practice Address - Phone:469-362-8004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX669671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical