MEDICARE: BRITTANY DORMAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	011460	CT
2	1041S0200X	School Social Worker	011460	CT
3	1041C0700X	Clinical Social Worker	011460	CT

General Provider Information

NPI Number	:	1265252225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY DORMAN LCSW

Provider Business Mailing Address
First Line	:	146 WILDCAT RD
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443-2434
Country	:	US
Telephone Number	:	203-415-4270
Fax Number	:

Provider Business Practice Location Address
First Line	:	146 WILDCAT RD
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443-2434
Country	:	US
Telephone Number	:	203-415-4270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	10/15/2024

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