MEDICARE: DOROTHY PRESTON PH.D

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	103T00000X	Psychologist	1638	AZ

General Provider Information

NPI Number	:	1881099836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY PRESTON PH.D

Provider Business Mailing Address
First Line	:	1646 N LITCHFIELD RD
Second Line	:	SUITE 200
City	:	GOODYEAR
State	:	AZ
Zip	:	85395-1203
Country	:	US
Telephone Number	:	623-643-9598
Fax Number	:	623-478-0960

Provider Business Practice Location Address
First Line	:	1646 N LITCHFIELD RD
Second Line	:	SUITE 200
City	:	GOODYEAR
State	:	AZ
Zip	:	85395-1203
Country	:	US
Telephone Number	:	623-643-9598
Fax Number	:	623-478-0960

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

Provider Enumeration Date	:	11/01/2014
Last Update Date	:	11/01/2014

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