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General NPI Number Information
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NPI Number | 1750470852
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Entity Type | Individual
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Provider Name | DONALD D DOORNBOS LCSW-R
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 38 RIVERSIDE DR
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City | BINGHAMTON
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State | NY
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Zip | 13905-4596
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Country | US
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Telephone | 607-765-6597
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Fax | 607-203-1668
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Provider Business Mailing Address
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Address Line | 38 RIVERSIDE DR
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City | BINGHAMTON
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State | NY
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Zip | 13905-4596
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Country | US
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Telephone | 607-765-6597
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Fax | 607-203-1668
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 030819
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License Number State | NY
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