Healthcare Provider Details

I. General information

NPI: 1053822544
Provider Name (Legal Business Name): DUFORT PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BLOOMINGDALE RD SUITE 6
STATEN ISLAND NY
10309
US

IV. Provider business mailing address

401 BLOOMINGDALE RD STE 6
STATEN ISLAND NY
10309-2070
US

V. Phone/Fax

Practice location:
  • Phone: 347-880-2150
  • Fax:
Mailing address:
  • Phone: 347-880-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAWSON DUFORT
Title or Position: OWNER
Credential: PHD
Phone: 347-880-2150