Provider Demographics
NPI:1295292233
Name:DORVIL PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:DORVIL PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLEDICIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORVIL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:609-532-0005
Mailing Address - Street 1:258 PENNINGTON LAWRENCEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-5125
Mailing Address - Country:US
Mailing Address - Phone:609-532-0005
Mailing Address - Fax:
Practice Address - Street 1:508B WHITE HORSE AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-1416
Practice Address - Country:US
Practice Address - Phone:609-393-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty