Provider Demographics
NPI:1093849168
Name:DORPH, YONINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YONINA
Middle Name:
Last Name:DORPH
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 1:1696 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1803
Mailing Address - Country:US
Mailing Address - Phone:617-413-3719
Mailing Address - Fax:
Practice Address - Street 1:1696 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1803
Practice Address - Country:US
Practice Address - Phone:617-413-3719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8698103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist