MEDICARE: DR. DOROTA UZDAWINIS PH.D., LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	004220	NY
2	103TC0700X	Clinical Psychologist	021252	NY

General Provider Information

NPI Number	:	1770716854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOROTA UZDAWINIS PH.D., LMHC

Provider Business Mailing Address
First Line	:	169 ADELPHI ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-3301
Country	:	US
Telephone Number	:	917-771-3314
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 GREENE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-1221
Country	:	US
Telephone Number	:	917-771-3314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	05/14/2020

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