MEDICARE: ROSE MARIE DORMUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1689905820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE MARIE DORMUS

Provider Business Mailing Address
First Line	:	6 WAYNE ST APT 2
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02121-3014
Country	:	US
Telephone Number	:	617-708-0838
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 WAYNE ST APT 2
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02121-3014
Country	:	US
Telephone Number	:	617-708-0838
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	01/28/2010

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