Provider Demographics
NPI:1114024387
Name:DORMER, HEATHER
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:DORMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 HARDY RD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-2828
Mailing Address - Country:US
Mailing Address - Phone:603-432-4932
Mailing Address - Fax:
Practice Address - Street 1:430 N CANAL ST
Practice Address - Street 2:FSMV
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1246
Practice Address - Country:US
Practice Address - Phone:978-327-6618
Practice Address - Fax:978-327-6601
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1131731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23879Medicare ID - Type Unspecified