Provider Demographics
NPI:1720646425
Name:DORMEVIL, NISHA
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:DORMEVIL
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 1:89 EASTON STREET ALLSTON BOSTON
Mailing Address - Street 2:1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-1408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:89 EASTON STREET ALLSTON BOSTON
Practice Address - Street 2:1
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-1408
Practice Address - Country:US
Practice Address - Phone:857-266-8271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst