Healthcare Provider Details

I. General information

NPI: 1083542211
Provider Name (Legal Business Name): VALERIYA DVORKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 86TH ST FL 3
BROOKLYN NY
11214-4440
US

IV. Provider business mailing address

2502 86TH ST FL 3
BROOKLYN NY
11214-4440
US

V. Phone/Fax

Practice location:
  • Phone: 347-391-4205
  • Fax:
Mailing address:
  • Phone: 347-391-4205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number017904-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: