Provider Demographics
NPI:1780123554
Name:DORVIL, MARC
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:DORVIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 SW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-6654
Mailing Address - Country:US
Mailing Address - Phone:954-478-2821
Mailing Address - Fax:
Practice Address - Street 1:4420 SW 23RD ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33317-6654
Practice Address - Country:US
Practice Address - Phone:954-478-2821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician