Provider Demographics
NPI:1437667888
Name:DORLER, JAELA M
Entity Type:Individual
Prefix:MRS
First Name:JAELA
Middle Name:M
Last Name:DORLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2305
Mailing Address - Country:US
Mailing Address - Phone:850-374-2002
Mailing Address - Fax:
Practice Address - Street 1:10920 MOSS PARK RD STE 130
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6087
Practice Address - Country:US
Practice Address - Phone:407-930-4339
Practice Address - Fax:407-745-0316
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-33008103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst