Provider Demographics
NPI:1801812706
Name:DORMAN, MARSHA N (PHD)
Entity type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:N
Last Name:DORMAN
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 1:1218 CHESTNUT ST
Mailing Address - Street 2:#607
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4825
Mailing Address - Country:US
Mailing Address - Phone:215-625-9655
Mailing Address - Fax:215-625-8524
Practice Address - Street 1:1218 CHESTNUT ST
Practice Address - Street 2:#607
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4825
Practice Address - Country:US
Practice Address - Phone:215-625-9655
Practice Address - Fax:215-625-8524
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0120401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA640057OtherHIGHMARK BC/BS
PA640057OtherHIGHMARK BC/BS