Provider Demographics
NPI:1518381284
Name:DORVELUS, EMMANUEL (MED LMHC)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:DORVELUS
Suffix:
Gender:M
Credentials:MED LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-5832
Mailing Address - Country:US
Mailing Address - Phone:617-639-6968
Mailing Address - Fax:
Practice Address - Street 1:360 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-5832
Practice Address - Country:US
Practice Address - Phone:617-639-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health