Basic Information
| Provider Information | |||||||||
| NPI: | 1164887220 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOR | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 197 SYLVESTER ST | ||||||||
| Address2: | |||||||||
| City: | WESTBURY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115903907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167101729 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2277 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | BALDWIN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115103148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163775400 | ||||||||
| FaxNumber: | 5163775490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2015 | ||||||||
| LastUpdateDate: | 12/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 093359 | NY | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 093359 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.