Provider Demographics
NPI:1447756614
Name:DORVAL, JENNIFER CLAIRE (MED)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CLAIRE
Last Name:DORVAL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 CHAPMAN ST FL 1
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2425
Mailing Address - Country:US
Mailing Address - Phone:413-522-6926
Mailing Address - Fax:
Practice Address - Street 1:108A N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUNDERLAND
Practice Address - State:MA
Practice Address - Zip Code:01375-9502
Practice Address - Country:US
Practice Address - Phone:413-665-8717
Practice Address - Fax:413-665-9383
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker