Provider Demographics
NPI:1770857393
Name:DORR, JUDITH M (AA)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:M
Last Name:DORR
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5627
Mailing Address - Country:US
Mailing Address - Phone:413-443-9599
Mailing Address - Fax:
Practice Address - Street 1:56 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5627
Practice Address - Country:US
Practice Address - Phone:413-443-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist