MEDICARE: DR. TERRY DORNAK PSY.D.

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	103TC0700X	Clinical Psychologist	071009088	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902286974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY DORNAK PSY.D.

Provider Business Mailing Address
First Line	:	8941 MARMORA AVE
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2448
Country	:	US
Telephone Number	:	872-999-0542
Fax Number	:	847-972-6445

Provider Business Practice Location Address
First Line	:	6300 CORPORATE CT STE 103
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3513
Country	:	US
Telephone Number	:	312-781-2850
Fax Number	:

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

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	01/27/2026

Similar Medicare Providers

1477551497 — EMILIO DELVALLE M.D.
Practice Location Address:

6300 CORPORATE CT , STE 103
FORT MYERS, FL
33919-3513

Practice Phone: 239-277-7666
Practice Fax: 239-277-1064

1518055201 — PHYLLIS C. WEBER L.AC.
Practice Location Address:

6300 CORPORATE CT STE 104
FORT MYERS, FL
33919-3513

Practice Phone: 239-936-4199
Practice Fax:

1518088517 — EMILIO DEL VALLE, M.D., P.A.
Practice Location Address:

6300 CORPORATE CT STE 103
FORT MYERS, FL
33919-3513

Practice Phone: 239-277-7666
Practice Fax: 239-277-1064

1366694515 — TRICIA RENEE ROY LMT, NCTMB
Practice Location Address:

6300 CORPORATE CT
FORT MYERS, FL
33919-3513

Practice Phone: 239-437-8386
Practice Fax: 239-482-8052

1679091367 — LIZANDRA C GUTIERREZ RBT
Practice Location Address:

6300 CORPORATE CT STE 102
FORT MYERS, FL
33919-3513

Practice Phone: 239-689-8204
Practice Fax:

1801396742 — FT. MYERS MRI, LLC
Practice Location Address:

6300 CORPORATE CT STE 101
FORT MYERS, FL
33919-3513

Practice Phone: 239-689-3695
Practice Fax:

Directions to “ DR. TERRY DORNAK PSY.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.