Provider Demographics
NPI:1538284815
Name:DORF, MYRA S (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:S
Last Name:DORF
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7038
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-7038
Mailing Address - Country:US
Mailing Address - Phone:847-236-1945
Mailing Address - Fax:847-236-9787
Practice Address - Street 1:666 DUNDEE RD
Practice Address - Street 2:SUITE 604
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2727
Practice Address - Country:US
Practice Address - Phone:847-530-6972
Practice Address - Fax:847-236-9787
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional