Healthcare Provider Details

I. General information

NPI: 1730407404
Provider Name (Legal Business Name): DAMARIS DORCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 SKYVIEW TER
MANCHESTER CT
06040-7076
US

IV. Provider business mailing address

58 SKYVIEW TERRACE
MANCHESTER CT
06040-7076
US

V. Phone/Fax

Practice location:
  • Phone: 860-647-8838
  • Fax:
Mailing address:
  • Phone: 860-527-1124
  • Fax: 860-724-2539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: