Provider Demographics
NPI:1710618186
Name:DORCIUS, KAELONNI
Entity Type:Individual
Prefix:
First Name:KAELONNI
Middle Name:
Last Name:DORCIUS
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 1:1650 OSCEOLA DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-5038
Mailing Address - Country:US
Mailing Address - Phone:561-803-8880
Mailing Address - Fax:877-409-1795
Practice Address - Street 1:1650 OSCEOLA DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-5038
Practice Address - Country:US
Practice Address - Phone:561-803-8880
Practice Address - Fax:877-409-1795
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW92491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLISW9249OtherSOCIAL WORKER