MEDICARE: MS. DONNA W SORGEN 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	101YP2500X	Professional Counselor	0701004308	VA
2	101YM0800X	Mental Health Counselor	004656-01	NY

General Provider Information

NPI Number	:	1841469707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA W SORGEN LMHC

Provider Business Mailing Address
First Line	:	15 PINE GROVE ST
Second Line	:
City	:	WOODSTOCK
State	:	NY
Zip	:	12498-1507
Country	:	US
Telephone Number	:	804-310-5650
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 PINE GROVE ST
Second Line	:
City	:	WOODSTOCK
State	:	NY
Zip	:	12498-1507
Country	:	US
Telephone Number	:	804-310-5650
Fax Number	:

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

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	12/04/2024

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