Provider Demographics
NPI:1184043549
Name:JOHN W. DORAN, LCSW PA
Entity Type:Organization
Organization Name:JOHN W. DORAN, LCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DORAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW PA
Authorized Official - Phone:954-253-4060
Mailing Address - Street 1:1881 NE 26TH ST
Mailing Address - Street 2:SUITE 212-G
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1416
Mailing Address - Country:US
Mailing Address - Phone:954-253-4060
Mailing Address - Fax:954-568-2336
Practice Address - Street 1:1881 NE 26TH ST
Practice Address - Street 2:SUITE 212-G
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1416
Practice Address - Country:US
Practice Address - Phone:954-253-4060
Practice Address - Fax:954-568-2336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty