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General NPI Number Information
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NPI Number | 1962018713
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Entity Type | Organization
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Legal Business Name | THE DORM LCSW, PLLC
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Dates
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Enumeration Date | 09/17/2020
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 175 W 72ND ST FRNT 2
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City | NEW YORK
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State | NY
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Zip | 10023-3203
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Country | US
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Telephone | 877-909-3676
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Fax |
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Provider Business Mailing Address
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Address Line | 175 W 72ND ST FRNT 2
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City | NEW YORK
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State | NY
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Zip | 10023-3203
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL OPERATIONS
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Name | LAURA BAKER
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Credential |
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Telephone | 202-893-2106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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