Provider Demographics
NPI:1366132961
Name:DORAN, CAROLINE GRACE (MED)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:GRACE
Last Name:DORAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1815
Mailing Address - Country:US
Mailing Address - Phone:610-505-6020
Mailing Address - Fax:
Practice Address - Street 1:121 N WAYNE AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3542
Practice Address - Country:US
Practice Address - Phone:610-574-0674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling