Provider Demographics
NPI:1346263803
Name:GOLDFARB, DORI (PHD)
Entity Type:Individual
Prefix:
First Name:DORI
Middle Name:
Last Name:GOLDFARB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6023
Mailing Address - Country:US
Mailing Address - Phone:941-365-2962
Mailing Address - Fax:941-952-9705
Practice Address - Street 1:2155 MAIN ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6023
Practice Address - Country:US
Practice Address - Phone:941-365-2962
Practice Address - Fax:941-952-9705
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5872103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54421Medicare ID - Type Unspecified