Provider Demographics
NPI:1083724686
Name:DVORKIN, KATE MARIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATE
Middle Name:MARIA
Last Name:DVORKIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 KING ST #4F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014
Mailing Address - Country:US
Mailing Address - Phone:212-243-1773
Mailing Address - Fax:
Practice Address - Street 1:291 WALL ST STE 2A
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3849
Practice Address - Country:US
Practice Address - Phone:845-594-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010675103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01259241Medicaid