Provider Demographics
NPI:1164616561
Name:DORSEY, MICHAEL F (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:DORSEY
Suffix:
Gender:M
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 PERRY AVENUE
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703
Mailing Address - Country:US
Mailing Address - Phone:508-455-6200
Mailing Address - Fax:508-455-6211
Practice Address - Street 1:33 PERRY AVENUE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703
Practice Address - Country:US
Practice Address - Phone:508-455-6200
Practice Address - Fax:508-455-6211
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5070103TB0200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04783OtherBCBS
MAR84374Medicare UPIN