Healthcare Provider Details

I. General information

NPI: 1912372012
Provider Name (Legal Business Name): JUDITH DORVIL MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3314 MOUNT PLEASANT ST NW
WASHINGTON DC
20010-1829
US

IV. Provider business mailing address

3314 MOUNT PLEASANT ST NW
WASHINGTON DC
20010-1829
US

V. Phone/Fax

Practice location:
  • Phone: 202-352-8587
  • Fax:
Mailing address:
  • Phone: 202-352-8587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: