Provider Demographics
NPI:1790345288
Name:DORIA, PETER EDWARD (LCSW)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:EDWARD
Last Name:DORIA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 1ST AVE APT 19
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2771
Mailing Address - Country:US
Mailing Address - Phone:203-305-6037
Mailing Address - Fax:
Practice Address - Street 1:11 WOODLAND RD STE 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2380
Practice Address - Country:US
Practice Address - Phone:203-800-6159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10589104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker