Provider Demographics
NPI:1912372012
Name:DORVIL, JUDITH (MA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:DORVIL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 MOUNT PLEASANT ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1829
Mailing Address - Country:US
Mailing Address - Phone:202-352-8587
Mailing Address - Fax:
Practice Address - Street 1:3314 MOUNT PLEASANT ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1829
Practice Address - Country:US
Practice Address - Phone:202-352-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool