Provider Demographics
NPI:1497878599
Name:DORRIS, NANCY (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DORRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 WEST 239TH STREET
Mailing Address - Street 2:BB
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:718-549-0641
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:620 W 239TH ST
Practice Address - Street 2:BB
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1242
Practice Address - Country:US
Practice Address - Phone:718-549-0641
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0529831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00665274Medicaid
NYW92171Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER