Provider Demographics
NPI:1558860478
Name:DORSEY, BREA MARIE (MS LBS)
Entity Type:Individual
Prefix:
First Name:BREA
Middle Name:MARIE
Last Name:DORSEY
Suffix:
Gender:F
Credentials:MS LBS
Other - Prefix:
Other - First Name:BREA
Other - Middle Name:MARIE
Other - Last Name:WOODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:502 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:19018-2108
Mailing Address - Country:US
Mailing Address - Phone:215-760-0587
Mailing Address - Fax:
Practice Address - Street 1:170 N HENDERSON RD STE 200
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4422
Practice Address - Country:US
Practice Address - Phone:856-346-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003727103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst