Provider Demographics
NPI:1689905820
Name:DORMUS, ROSE MARIE
Entity Type:Individual
Prefix:
First Name:ROSE MARIE
Middle Name:
Last Name:DORMUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WAYNE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-3014
Mailing Address - Country:US
Mailing Address - Phone:617-708-0838
Mailing Address - Fax:
Practice Address - Street 1:6 WAYNE ST APT 2
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-3014
Practice Address - Country:US
Practice Address - Phone:617-708-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor