Provider Demographics
NPI:1447445606
Name:DORSCH, KRISTIN MARIE
Entity type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:MARIE
Last Name:DORSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2892 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34715-8197
Mailing Address - Country:US
Mailing Address - Phone:407-902-9032
Mailing Address - Fax:352-432-3148
Practice Address - Street 1:2892 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34715-8197
Practice Address - Country:US
Practice Address - Phone:407-902-9032
Practice Address - Fax:352-432-3148
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-07-3774103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst