Provider Demographics
NPI:1609672062
Name:MCINTOSH, DORNETT ELIZABETH
Entity type:Individual
Prefix:
First Name:DORNETT
Middle Name:ELIZABETH
Last Name:MCINTOSH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 WETHERSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-3180
Mailing Address - Country:US
Mailing Address - Phone:860-830-9778
Mailing Address - Fax:
Practice Address - Street 1:846 WETHERSFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-3180
Practice Address - Country:US
Practice Address - Phone:860-830-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty