Basic Information
| Provider Information | |||||||||
| NPI: | 1659810166 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DORR | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | JEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2073 GARDEN ST | ||||||||
| Address2: | |||||||||
| City: | TITUSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327963243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218883020 | ||||||||
| FaxNumber: | 6612634584 | ||||||||
| Practice Location | |||||||||
| Address1: | 2073 GARDEN ST | ||||||||
| Address2: | |||||||||
| City: | TITUSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327963243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218883020 | ||||||||
| FaxNumber: | 6612634584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2017 | ||||||||
| LastUpdateDate: | 10/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.