Provider Demographics
NPI:1952732026
Name:DORVIL, CLEDICIANNE
Entity Type:Individual
Prefix:DR
First Name:CLEDICIANNE
Middle Name:
Last Name:DORVIL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CLEDICIANNE
Other - Middle Name:
Other - Last Name:DORVIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:120 ROBERTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2447
Mailing Address - Country:US
Mailing Address - Phone:609-532-0005
Mailing Address - Fax:
Practice Address - Street 1:904 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-5318
Practice Address - Country:US
Practice Address - Phone:609-393-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ692206103TS0200X
PAPS017367103TC2200X
NJ35SI00522100103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool