Provider Demographics
NPI:1396853057
Name:JAMES J DAURORA PHD PA
Entity Type:Organization
Organization Name:JAMES J DAURORA PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DAURORA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:651-644-2248
Mailing Address - Street 1:91 N SNELLING AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6756
Mailing Address - Country:US
Mailing Address - Phone:651-644-2248
Mailing Address - Fax:651-641-1074
Practice Address - Street 1:91 N SNELLING AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6756
Practice Address - Country:US
Practice Address - Phone:651-644-2248
Practice Address - Fax:651-641-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty