Provider Demographics
NPI:1639108426
Name:DORSEY, CYNTHIA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:M
Last Name:DORSEY
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 1:1266 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3060
Mailing Address - Country:US
Mailing Address - Phone:978-369-6568
Mailing Address - Fax:978-369-6668
Practice Address - Street 1:1266 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3060
Practice Address - Country:US
Practice Address - Phone:978-369-6568
Practice Address - Fax:978-369-6668
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2024-02-20
Deactivation Date:2023-10-23
Deactivation Code:
Reactivation Date:2024-02-20
Provider Licenses
StateLicense IDTaxonomies
MA6115103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05375OtherBLUE CROSS & BLUE SHIELD
MA274680000OtherMAGELLAN
MAW05375Medicare PIN