Provider Demographics
NPI:1275719767
Name:DOROSARIO, KENNETH ARNOLD (LMHC, MT-BC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ARNOLD
Last Name:DOROSARIO
Suffix:
Gender:M
Credentials:LMHC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 CHESTNUT ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1101
Mailing Address - Country:US
Mailing Address - Phone:617-710-4074
Mailing Address - Fax:
Practice Address - Street 1:987 CHESTNUT ST
Practice Address - Street 2:UNIT 3
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1101
Practice Address - Country:US
Practice Address - Phone:617-710-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health