1962663591 NPI number — MR. WILLIAM GERARD DORSEY LCSW

Table of content: MR. WILLIAM GERARD DORSEY LCSW (NPI 1962663591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962663591 NPI number — MR. WILLIAM GERARD DORSEY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DORSEY
Provider First Name:
WILLIAM
Provider Middle Name:
GERARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962663591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 BICENTENNIAL WAY
Provider Second Line Business Mailing Address:
KAISER PERMANENTE PALLIATIVE CARE
Provider Business Mailing Address City Name:
SANTA ROSA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95403-2149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-393-4480
Provider Business Mailing Address Fax Number:
707-393-3498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 BICENTENNIAL WAY
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE PALLIATIVE CARE
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95403-2149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-393-4480
Provider Business Practice Location Address Fax Number:
707-393-3498
Provider Enumeration Date:
06/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 10709 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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