MEDICARE: NICOLE B DORSEY PHD

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	103TC0700X	Clinical Psychologist	31047	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376673400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE B DORSEY PHD

Provider Business Mailing Address
First Line	:	7410 E SUDDLEY CASTLE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-3535
Country	:	US
Telephone Number	:	832-545-5498
Fax Number	:

Provider Business Practice Location Address
First Line	:	7410 E SUDDLEY CASTLE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-3535
Country	:	US
Telephone Number	:	832-545-5498
Fax Number	:

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/20/2010

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