Provider Demographics
NPI:1437516119
Name:ADRAGNA, DORI A (PHD, EDS)
Entity Type:Individual
Prefix:
First Name:DORI
Middle Name:A
Last Name:ADRAGNA
Suffix:
Gender:F
Credentials:PHD, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 E. NIAGARA ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5027
Mailing Address - Country:US
Mailing Address - Phone:970-497-4921
Mailing Address - Fax:970-701-4161
Practice Address - Street 1:1550 E NIAGARA ROAD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5027
Practice Address - Country:US
Practice Address - Phone:970-497-4921
Practice Address - Fax:970-701-4161
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004594103T00000X
CONLC.0104881103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty