Healthcare Provider Details

I. General information

NPI: 1710187067
Provider Name (Legal Business Name): GARY GUSSMAN DOREY-STEIN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 LEOPARD RD BUILDING 2 SUITE 101
PAOLI PA
19301-1552
US

IV. Provider business mailing address

43 LEOPARD ROAD BUILDING 2 SUITE 101
PAOLI PA
19301-1743
US

V. Phone/Fax

Practice location:
  • Phone: 610-251-9545
  • Fax: 610-251-9545
Mailing address:
  • Phone: 610-251-9545
  • Fax: 610-251-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS005118L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: