Provider Demographics
NPI:1982373601
Name:POWERS, DOROTHY JANE
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JANE
Last Name:POWERS
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 1:935 OLD QUAKER RD
Mailing Address - Street 2:
Mailing Address - City:ETTERS
Mailing Address - State:PA
Mailing Address - Zip Code:17319-9667
Mailing Address - Country:US
Mailing Address - Phone:831-212-2847
Mailing Address - Fax:
Practice Address - Street 1:355 N 21ST ST STE 208
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-3707
Practice Address - Country:US
Practice Address - Phone:831-212-2847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001284106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist