Provider Demographics
NPI:1891144127
Name:DORR, BERNADETTE (PHD)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:DORR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 COBBLESTONE AVE E
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4587
Mailing Address - Country:US
Mailing Address - Phone:614-805-7638
Mailing Address - Fax:
Practice Address - Street 1:1000 E BROAD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1381
Practice Address - Country:US
Practice Address - Phone:614-834-0586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4978103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist