Provider Demographics
NPI:1083045017
Name:RAM, DORRIT (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DORRIT
Middle Name:
Last Name:RAM
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 1:2100 LEE RD STE A
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1862
Mailing Address - Country:US
Mailing Address - Phone:407-644-7593
Mailing Address - Fax:407-209-0289
Practice Address - Street 1:2100 LEE RD STE A
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1862
Practice Address - Country:US
Practice Address - Phone:407-644-7593
Practice Address - Fax:407-209-0289
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089178-1104100000X
FLSW140291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY089178-1Medicaid