Provider Demographics
NPI:1487017828
Name:DORIA, MICHAEL JOHN (PHD, MPH, MRC, MC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:DORIA
Suffix:
Gender:M
Credentials:PHD, MPH, MRC, MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 HUGUENOT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7710
Mailing Address - Country:US
Mailing Address - Phone:914-246-4100
Mailing Address - Fax:888-301-8044
Practice Address - Street 1:173 HUGUENOT ST STE 200
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-7710
Practice Address - Country:US
Practice Address - Phone:914-246-4100
Practice Address - Fax:888-301-8044
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-02
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4669101Y00000X
210101101Y00000X
00071051101YA0400X
MECC3015101YM0800X
NY003308-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)