Provider Demographics
NPI:1033345186
Name:JUDI DOBNER THERAPIST AGENCY LLC
Entity Type:Organization
Organization Name:JUDI DOBNER THERAPIST AGENCY LLC
Other - Org Name:JDTA
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:845-368-7927
Mailing Address - Street 1:386 ROUTE 59
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3428
Mailing Address - Country:US
Mailing Address - Phone:845-368-7927
Mailing Address - Fax:845-368-7929
Practice Address - Street 1:386 ROUTE 59
Practice Address - Street 2:SUITE 102
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-3428
Practice Address - Country:US
Practice Address - Phone:845-368-7927
Practice Address - Fax:845-368-7929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency