Provider Demographics
NPI:1477750404
Name:MARTIN-NEVILLE, DOROTHY AGNES (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:AGNES
Last Name:MARTIN-NEVILLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WINTONBURY MALL
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2466
Mailing Address - Country:US
Mailing Address - Phone:860-286-5400
Mailing Address - Fax:860-286-5402
Practice Address - Street 1:2 WINTONBURY MALL
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2466
Practice Address - Country:US
Practice Address - Phone:860-286-5400
Practice Address - Fax:860-286-5402
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLMFT - 000492174400000X
CTLPC - 000800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist