Provider Demographics
NPI:1790861367
Name:PANISSIDI, DOROTHY (LCSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:PANISSIDI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-2339
Mailing Address - Country:US
Mailing Address - Phone:757-237-9377
Mailing Address - Fax:
Practice Address - Street 1:232 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-2339
Practice Address - Country:US
Practice Address - Phone:757-237-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA08416001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA382811OtherTRIGON
VA382812OtherTRIGON
VA008929751Medicaid
VA146823OtherTRIGON