Provider Demographics
NPI:1932123619
Name:PLATT, DOLLY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOLLY
Middle Name:A
Last Name:PLATT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1550 BAYSIDE DR
Mailing Address - Street 2:SUITE 13
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1711
Mailing Address - Country:US
Mailing Address - Phone:949-640-6247
Mailing Address - Fax:949-720-8169
Practice Address - Street 1:1550 BAYSIDE DR
Practice Address - Street 2:SUITE 13
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-1711
Practice Address - Country:US
Practice Address - Phone:949-640-6247
Practice Address - Fax:949-720-8169
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8586103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8586BMedicare ID - Type UnspecifiedMEDICARE