Provider Demographics
NPI:1235840067
Name:KATHY DOR PYSCHOTHERAPY, LCSW, PLLC
Entity Type:Organization
Organization Name:KATHY DOR PYSCHOTHERAPY, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:516-710-1729
Mailing Address - Street 1:1080 OLD COUNTRY RD # 1129
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5625
Mailing Address - Country:US
Mailing Address - Phone:774-481-1590
Mailing Address - Fax:
Practice Address - Street 1:197 SYLVESTER ST
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-3907
Practice Address - Country:US
Practice Address - Phone:774-481-1590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty