Provider Demographics
NPI:1912358383
Name:DOBRATZ, SUSAN GORHAM
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GORHAM
Last Name:DOBRATZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WHITE VIOLET LN
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2659
Mailing Address - Country:US
Mailing Address - Phone:774-413-9564
Mailing Address - Fax:
Practice Address - Street 1:1 WHITE VIOLET LN
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2659
Practice Address - Country:US
Practice Address - Phone:774-413-9564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst