MEDICARE: MR. JAMES PETER DORAN 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	1041C0700X	Clinical Social Worker	0904000288	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10607	OTHER	VA	CIGNA BEHAVIORAL HEALTH
2	094949	OTHER	VA	ANTHEM BLUE CROSS/ BLUE S

General Provider Information

NPI Number	:	1346264199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES PETER DORAN LCSW

Provider Business Mailing Address
First Line	:	10106 KRAUSE RD
Second Line	:	SUITE 100C
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6572
Country	:	US
Telephone Number	:	804-751-0277
Fax Number	:	804-751-9086

Provider Business Practice Location Address
First Line	:	10106 KRAUSE RD
Second Line	:	SUITE 100C
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6572
Country	:	US
Telephone Number	:	804-751-0277
Fax Number	:	804-751-9086

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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