Provider Demographics
NPI:1780156000
Name:DORSAINVIL, TAISHA
Entity type:Individual
Prefix:
First Name:TAISHA
Middle Name:
Last Name:DORSAINVIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HIGHLAND AVE APT 26
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4525
Mailing Address - Country:US
Mailing Address - Phone:617-615-1115
Mailing Address - Fax:
Practice Address - Street 1:43 HIGHLAND AVE APT 26
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4525
Practice Address - Country:US
Practice Address - Phone:617-615-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor