Provider Demographics
NPI:1376570200
Name:DORFMAN, AMY L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:DORFMAN
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 1:21 CANNONADE DR
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1937
Mailing Address - Country:US
Mailing Address - Phone:732-577-8982
Mailing Address - Fax:
Practice Address - Street 1:21 CANNONADE DR
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1937
Practice Address - Country:US
Practice Address - Phone:732-577-8982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC05806101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ732686Medicare ID - Type Unspecified