Provider Demographics
NPI:1801209820
Name:DORVILIER, DAVE
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:
Last Name:DORVILIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 HIGH ST
Mailing Address - Street 2:3
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:216 HIGH ST
Practice Address - Street 2:3
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7035
Practice Address - Country:US
Practice Address - Phone:617-651-1735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2192641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical