Provider Demographics
NPI:1023678364
Name:SEGER CALOS, DORIE (CBD)
Entity type:Individual
Prefix:
First Name:DORIE
Middle Name:
Last Name:SEGER CALOS
Suffix:
Gender:F
Credentials:CBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 COLONY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2403
Mailing Address - Country:US
Mailing Address - Phone:860-977-3034
Mailing Address - Fax:
Practice Address - Street 1:23 COLONY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2403
Practice Address - Country:US
Practice Address - Phone:860-977-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTNA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty