Provider Demographics
NPI:1497354989
Name:DORZIN, MICHELON (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MICHELON
Middle Name:
Last Name:DORZIN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:MR
Other - First Name:MICHELON
Other - Middle Name:
Other - Last Name:DORZIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:3404 BEVERLEY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5014
Mailing Address - Country:US
Mailing Address - Phone:718-355-1728
Mailing Address - Fax:
Practice Address - Street 1:3404 BEVERLEY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5014
Practice Address - Country:US
Practice Address - Phone:718-355-1728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108229104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty