Provider Demographics
NPI:1730479916
Name:DOR, VERED (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VERED
Middle Name:
Last Name:DOR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9230 HECKSCHER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-2417
Mailing Address - Country:US
Mailing Address - Phone:847-980-8707
Mailing Address - Fax:
Practice Address - Street 1:14333 BEACH BLVD STE 33
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-1573
Practice Address - Country:US
Practice Address - Phone:847-980-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-09
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007907103TC0700X
FLPY10806103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL27-3916691OtherTAX ID