Provider Demographics
NPI:1396149266
Name:DORIS, JOAN MARIA (DSW, LICSW)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:MARIA
Last Name:DORIS
Suffix:
Gender:F
Credentials:DSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CRAWFORD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:STAR CITY
Mailing Address - State:WV
Mailing Address - Zip Code:26505-4001
Mailing Address - Country:US
Mailing Address - Phone:716-713-3684
Mailing Address - Fax:
Practice Address - Street 1:930 CHESTNUT RIDGE RD
Practice Address - Street 2:WVU DEPARTMENT OF BEHAVIORAL MEDICINE AND PSYCHIATRY
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2807
Practice Address - Country:US
Practice Address - Phone:304-293-2487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009444941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical