Provider Demographics
NPI:1841502499
Name:DORSEY, DAVID P (LCSW, LCDCS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:P
Last Name:DORSEY
Suffix:
Gender:M
Credentials:LCSW, LCDCS
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:P
Other - Last Name:DORSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LCDCS
Mailing Address - Street 1:66 PAVILION AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-1522
Mailing Address - Country:US
Mailing Address - Phone:401-461-9110
Mailing Address - Fax:401-461-9194
Practice Address - Street 1:66 PAVILION AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-1522
Practice Address - Country:US
Practice Address - Phone:401-461-9110
Practice Address - Fax:401-461-9194
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDCS00027101YA0400X
RICSW00486101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health