Provider Demographics
NPI:1194359190
Name:DINA BOCTOR LLC
Entity Type:Organization
Organization Name:DINA BOCTOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:DINA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BOCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-985-8751
Mailing Address - Street 1:90 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1735
Mailing Address - Country:US
Mailing Address - Phone:860-985-8751
Mailing Address - Fax:
Practice Address - Street 1:475 S MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3164
Practice Address - Country:US
Practice Address - Phone:860-985-8751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty