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General NPI Number Information
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NPI Number | 1790345288
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Entity Type | Individual
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Provider Name | PETER EDWARD DORIA LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 11 WOODLAND RD STE 2
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City | MADISON
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State | CT
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Zip | 06443-2380
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Country | US
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Telephone | 203-800-6159
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Fax |
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Provider Business Mailing Address
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Address Line | 790 1ST AVE APT 19
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City | WEST HAVEN
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State | CT
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Zip | 06516-2771
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Country | US
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Telephone | 203-305-6037
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 10589
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License Number State | CT
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