Healthcare Provider Details

I. General information

NPI: 1952732026
Provider Name (Legal Business Name): DR. CLEDICIANNE DORVIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLEDICIANNE DORVIL PSY.D.

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 02/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 RIVERSIDE AVE
TRENTON NJ
08618-5318
US

IV. Provider business mailing address

120 ROBERTSON AVE
MORRISVILLE PA
19067-2447
US

V. Phone/Fax

Practice location:
  • Phone: 609-393-1166
  • Fax:
Mailing address:
  • Phone: 609-532-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS017367
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number35SI00522100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number692206
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: