Provider Demographics
NPI:1225332570
Name:DORAN, RITA M (BCABA)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:M
Last Name:DORAN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 NE ENGLISH MANOR DR APT B
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4521
Mailing Address - Country:US
Mailing Address - Phone:814-880-3771
Mailing Address - Fax:
Practice Address - Street 1:609 NE ENGLISH MANOR DR APT B
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4521
Practice Address - Country:US
Practice Address - Phone:814-880-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-00-0005103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst