Provider Demographics
NPI:1346950680
Name:ULLENDORFF, DORIS EMMA (LCSW)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:EMMA
Last Name:ULLENDORFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 W END AVE APT 7B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4952
Mailing Address - Country:US
Mailing Address - Phone:212-877-9644
Mailing Address - Fax:
Practice Address - Street 1:318 W 108TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-2772
Practice Address - Country:US
Practice Address - Phone:646-596-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032513-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical