Provider Demographics
NPI:1447580154
Name:HEAD, DORIAN LISA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:DORIAN
Middle Name:LISA
Last Name:HEAD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LINDSLEY DR STE 203
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-4456
Mailing Address - Country:US
Mailing Address - Phone:973-998-7900
Mailing Address - Fax:973-998-7910
Practice Address - Street 1:25 LINDSLEY DR STE 203
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-998-7900
Practice Address - Fax:973-998-7910
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00505500101YP2500X
NJH20071777358802101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7794703OtherAGENCY MEDICAID PROVIDER NUMBER
NJ0023701OtherAGENCY MEDICAID PROVIDER NUMBER
NJ527486OtherAGENCY MEDICARE PROVIDER NUMBER