Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 4979 | OH |
Y | 103T00000X | Psychologist | 4979 | OH |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 4979 | OH |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 4979 | OH |
N | 103TF0000X | Family Psychologist | 4979 | OH |
NPI | 1205016557 |
---|---|
Provider Name | Constance Joan Dorr |
First Address | Toledo, OH 43606-1306 |
Second Address | Toledo, OH 43606-1306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2007 |
Last Update Date | 21/11/2007 |