Provider Demographics
NPI:1346336377
Name:DORN, HANNI L (PHD)
Entity Type:Individual
Prefix:DR
First Name:HANNI
Middle Name:L
Last Name:DORN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:640 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-4413
Mailing Address - Country:US
Mailing Address - Phone:914-381-9189
Mailing Address - Fax:
Practice Address - Street 1:800 WESTCHESTER AVE
Practice Address - Street 2:SUITE 641 N
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-1354
Practice Address - Country:US
Practice Address - Phone:914-481-8313
Practice Address - Fax:914-872-4051
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014354-1103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014354-1OtherSTATE LICENSE