Provider Demographics
NPI:1700304771
Name:JOSEPHS-SPAULDING, DOROTHEA (PHD)
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:
Last Name:JOSEPHS-SPAULDING
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 1:209 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:HENRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18332-7801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 WALNUT LN
Practice Address - Street 2:
Practice Address - City:HENRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18332-7801
Practice Address - Country:US
Practice Address - Phone:954-309-8577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA37PC00531300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional