Provider Demographics
NPI:1164619490
Name:DESPRES, DOLORES (MSW)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:DESPRES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:
Other - Last Name:VAILLAN COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072
Mailing Address - Country:US
Mailing Address - Phone:207-283-0690
Mailing Address - Fax:
Practice Address - Street 1:22 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-2327
Practice Address - Country:US
Practice Address - Phone:207-283-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC011411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical