Provider Demographics
NPI:1013181932
Name:WATKINS, DORENE CAROL (MED)
Entity Type:Individual
Prefix:MS
First Name:DORENE
Middle Name:CAROL
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BROADWAY
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1607
Mailing Address - Country:US
Mailing Address - Phone:917-305-7881
Mailing Address - Fax:917-305-7980
Practice Address - Street 1:50 BROADWAY
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1607
Practice Address - Country:US
Practice Address - Phone:917-305-7881
Practice Address - Fax:917-305-7980
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool