Provider Demographics
NPI:1508833658
Name:PARKER, DOROTHY B (LCSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:B
Last Name:PARKER
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 1:419A KING ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-1206
Mailing Address - Country:US
Mailing Address - Phone:570-424-8657
Mailing Address - Fax:570-424-9783
Practice Address - Street 1:419A KING ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-1206
Practice Address - Country:US
Practice Address - Phone:570-424-8657
Practice Address - Fax:570-424-9783
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW012856101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA638852Medicare ID - Type Unspecified