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General NPI Number Information
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NPI Number | 1336277524
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Entity Type | Individual
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Provider Name | KELLY ELIZABETH DVORIN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 55 NORTH RD STE 220B
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City | BEDFORD
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State | MA
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Zip | 01730-1078
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Country | US
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Telephone | 978-735-9675
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Fax |
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Provider Business Mailing Address
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Address Line | 55 NORTH RD STE 220B
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City | BEDFORD
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State | MA
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Zip | 01730-1078
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Country | US
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Telephone | 978-735-9675
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 9816
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License Number State | MA
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