Provider Demographics
NPI:1265628572
Name:DORNEY, DAVID C (PHD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:DORNEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 LAMARTINE ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2280
Mailing Address - Country:US
Mailing Address - Phone:617-522-1478
Mailing Address - Fax:617-522-1478
Practice Address - Street 1:329 LAMARTINE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2280
Practice Address - Country:US
Practice Address - Phone:617-522-1478
Practice Address - Fax:617-522-1478
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health